I

1

I

I

SENDER

: COMPLETE THIS SECTION

•

Complete 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

.

Article Addressed to :

12/7/06 B .M .

AC 2007-022

Jack Caldwell

301 E . Harpole

W1lliamsville, IL 62693

2 . Article Number

(Transfer from service label)

L

PS Form

3811, February 2004

7006 0100 0000 7374 7576

RECEIVEDCLERK'S

OFFICE

DEC

2 2 2006

Pollution

STATE OFControl

ILLINOIS

Board

COMPLETE THIS SECTION ON DELIVERY

A. s

0 Agent

I'Addreesee

/

X

D

.

If

Is

YES,

delvery

enter

address

delivery

different

address

from

belowItem

:

1?

Pay-

U

No

Pv ar~r 95

aJ;if;aixsu;//e

!L 6%93

a Service Type

~CerHfled Mall

0 Express Mail

0 Registered

0

Return Receipt for Merchandise

0 Insured Mail

0 C.O .D.

4 . Restricted Delivery?

(Extra

Fee)

0

Yes

B .

by (Printed Name)

C. Daa/~eN~

Domestic Return Receipt

102595-02.M+t