ORIGINAL

I

COMPLETE THIS SECTION ON DELIVERY

eived by (Printed Name)

- w

(a--

C D

SENDER

: COMPLETE THIS SECTION

A . Signature

3S

0 Agent

0 Addresses

of

02.3

∎ Complete Items 1, 2, and 3

. Also complete

I

item 4 if Restricted Delivery is desired

.

∎ Print your name and address on the reverse

l

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

.

1

. Article Addressed to :

3/15/07

B .M .

PCB 2007-073

Bruce Carmen

Tellen,

Horberg, Smith &

Carmen, P.C .

124 W. Exchange Street

P .O . Box 179

Cambridge, IL 61238

2

. Article Number

(Transfer fmm service label)

PS Form 3811, February 2004

7001 1140 0002 7469 0275-

Domestic Retuh Receipt

D

. Is delivery address different from item ?

0 Yes

If YES, enter delivery address below:

0 No

ere Type

riffled Mall 0 Express Mail

Registered

0 Return Receipt for Merchandise

0

Insured Mail

0 C.O.D .

RECEIVEDCLERK'S

OFFICE

MAR 2

a

2007

Pollution

STATE OF

Control

ILLINOISBoard

ver

07

I I

102595-02-M-159

4 Restricted Delivery? (Extra Fee)

0 Yes