r

ORIGINAL

SENDER : COMPLETE THIS SECTION

p

items 1, 2, and 3 . Also complete

Item 4 If Restricted Delivery Is desired .

•

Print your name and address on the reverse

so that we can return the card to you .

•

Attach this card to the back of the mailpiece,

or on the front If space permits .

PS Form 3811, February 2004

Domestic Return Receipt

1 Article Addressed to :

11/16/06 B .D¢t

AC

2005-040

Wayne Klinger

Northern Illinois Service

Company

4781 Sandy Hollow Road

I

Rickford,

IL 61109

I

2. Article Number

I

(nansferfrdmservice tabel)

7005

1160

0002 2068 0749

~/

0 Agent

O Addressee

B

. Received

nted Name)

C

. Date f

Delivery

j- Free--;

D. Is delivery address different from item 1? O Yes

If YES, enter delivery address below:

0 No

RECEIVEDCLERK'S

OFFICE

N37 2

2006

Pollution

STATE OF

Control

ILLINOISBoard

COMPLETE THIS SECTION ON DELIVERY

Ice Type

Certified Mail 0 Express Mall

Registered

0 Return Receipt for Merchandise

0 Insured Mall

0 C.O.D .

4

. Restricted Delivery? (Extra Fee)

O Yes

102595-02-M-1540 ;