RECEIVEDCLERK'S

OFFICE

F ER t

? 2007

I

STATE OF ILLNO

SENDER :

COMPLETE THIS SECTION

Pollution Control B

Cn . ..^^tFrE

THIS

SECTION ON DELIVERY

a-

Up

a

Complete items 1, 2, and 3

. Also complete

A . S

•

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

:

1/26/07

B .M.

David K . Cox

David K . Cox

364

East Franklin

Street

I

Bement, IL

61813

I

PS Form

3811,

February 2004

•

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

.

Domestic Return Receipt

Agent

C] Addressee

K PH

"r)

C. Date t Delivery

D

. Is delivery address different from item 1? 13

Yes

If YES, enter delivery address below

:

0 No

ca Type

Mad Mail

0 Express Mall

Registered

12

Insured Mail

o

13

Return

c.oo.

Receipt for Merchandise

4

. Restricted Delivery? (Extra Fee)

o Yes

2 . Article

Number

j

(Transferfmmservic

e labs*

7000 0520

0012 3759

1468

Domestic Return Receipt

102595-02-M-1540

SENDER :

COMPLETE THIS

SECTION

( COMPLETE THIS

SECTION ON DELIVERY

• :10

1

4

. /1

. I ~ .

D. Is delivery address different from Item I?

It YES, enter delivery address below

:

3

o

AgentAddressee

Date of Delivery

Yes

1 . A3tlcie Addressed to

0

0

1/26/07 B .

AC 2007-021

Tim Walker

3

-710

IIYt 57 rvLrLS ~ ~

3610 Christmas Tree Road

Decatur, IL 62521

Ice Tips

Certified Mail

O

Express Mall

Registered

O

Return Receipt for Merchandise

o

Insured Mail

00.0 .0.

4

. Restricted

Delivery?

tExtm Fee)

O Yes

)

2

. Article Number

fTrenaferfrom service labep

7000

1140 0002

7469

0619

I PS Form 3811, February 2004

102595

.0244.1540