1. page 1

 
SENDER :
COMPLETE THIS SECTION
I ∎ Complete items 1, 2, and 3. Also complete
fern 4 if Restricted Delivery is desired .
∎ Print your name and address on the reverse
so that we can return the card to you .
I
i1
∎ Attach this card to the back of the mailpiece,
or on the front if space permits .
. Article Addressed to :
1/26/07
SAC
2005-040
IWayne Klinger
Northern Illinois Service Co
.
14781 Sandy Hollow Road
IRickford, IL
61109
II
B .M.
2
. Article Number
7000 0520
0012
7735
6898
(T-star
thorn
service
label)
February 2004
Domestic Return Receipt
PS Form
3811,
RECEIVEDCLERK'S
OFFICE
Pollution
STATE OF
Control
ILLINOISBoard
COMPLETE THIS SECTION ON DELIVERY
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enter
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different
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1? 0
4
. Restricted Delivery? (Extra Fee)
ice Type
rtiged Mail 0 Express Mail
Registered
O Return Receipt for Merchandise
0
Insured Mail 13 C .O.D .
O
Yes
02595-02-M-l540
COMPLETE THIS SECTION ON DELIVERY
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1?
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SENDER
:
COMPLETE THIS SECTION
,
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leta
Its,
4 if
Restricted Dell"8111
sdesired ∎ Print your name and address on the reverse
so that we can return the card to you
.
this
card to the
m ailpiece
.
I
on
the front or
Space Perm--
I I
I Article Addressed to
:
1/26/07
B .M
.
AC
2005-040
Peter DeBruyne
Peter DeBruyne, P .
C
.
1
838
North Main Street
I Rockford, IL
61103
I
re
00 AgentAddressee
C
. Date of Delivery
Z- tV
Type
fled Mail
O
Express Mall for Merchandise
Registered
0 Return Receipt
O
Insured Mall
0
C.O.D
.
4
. Restricted Delivery? (Extra Fee)
O
Yes
102595-02-M-1540
1
A . Signature
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B. Received by dntedName)
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