I

∎ Complete Items 1, 2, and

3 . Also complete

item 4 if Restricted Delivery is desired

.

∎ Print your name and address on the reverse

I

so that we can return the cardd to you

.

∎ Attach this card to the back of the mailpiece,

or on the front If space permits.

ORIGINAL

SENDER :

COMPLETE THIS SECTION

1 . Article Addressed to:

11/16/06 B .M .

AC 2005-040

Peter DeBruyne

Peter DeBruyne, P

.C .

838 North Main Street

Rockford, IL 61103

COMPLETE THIS SECTION ON DELIVERY

A. Signature

0 Agent

O

(JAi1A-

)10 0Addressee

S . Received by (Printed Name)

C . Dat of D ivery

IlIz

-2-106

_

D

. Is delivery address different from iterri 1? 13 yes

If YES, enter delivery address below:

0 No

X

RECEIVED

CLERK'S OFFICE

DEC Ct '

2006

STATE OF ILLINOIS

Pollution Control Board

3 . Service Type

0

Certified Mau 13 Express Mall

0 Registered

0

Return Receipt for Merchandise

0 Insured Mall

0 C.O.D.

4. Restricted Delivery? (Extra Fee)

0 Yes

2

. Article Number

i

(Transfer

from

sen/Ice label)

7006 0100 0000 7374 7514

PS Form

3811, February 2004

Domestic Return Receipt

102595-02-M-1540