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 : 2/15/07 B .M .

PCB 2005-049

Thomas G . Safley

Hoodge Dwyer Zeman

3150 Roland Avenue

Post Office Box 5776

Springfield, IL 62705-5776

PS Form 3811,

February 2004

COMPLETE THIS SECTION ON DELIVERY

2. Article Number

(Transfer from service label)

7001 1140 00027469 0589

X

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R wed by

(Printed Name)

X 1"C', Lee

.

e f Weliyac

9

1

1

D

. Is delivery address different from tern

1? 0 Yes

If YES, enter delivery address below :

0 No

Service Type

ed Mail 0 Express Mall

Registered

0 Return Receipt for Merchandise

0 Insured Mail

0 C.O .D

.

4. Restricted Delivery?

(&tree Fee)

13 Agent

0 Addresse

0 Yes

Domestic Return Receipt

102595-02-M-154

CIA I R EAE

VE~

tAPIR, 0'P 2-00?

PollutionSTATE

OF ntoBNB'

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