SENDER : COMPLETE THIS SECTION

I ∎ Complete Items 1, 2, and 3

. Also complete

item 4 if Restricted Delivery Is desired .

∎ Print your name and address on the revers

I

so that we can return the card to you .

∎ Attach this card to the back of the mailpiec

I

or on the front if space permits

.

1 . Article Addressed to

1/26/07 B .M .

PCB 2007-001

Kurt Carlson

3i

-Windsor Lake Parkway

I Loves ark, IL 61111

2 . Article Number

(rransferfrom service Iabe0

7001 1140 0002 7469 0794

PS

Form 3811, February 2004

Domestic Return Receipt

RECEIVED

CLERK'S

OFFICE

FCL 1

3

2007

STATE OF ILLINOIS

Pollution Control Board

(Printed Name)

C . Date of Delivery

0 . Is delivery address different from item 1? 0 yes

If YES, enter delivery address below

:

0 No

Ice Type

Mod Mail O Express Mail

Registered

E3 Return Receipt for Merchandise

O Insured Mail

0 C.O.D .

4

. Restricted Delivery? (Extra Fee)

0 Yes

10259502-M-1540