ORIGINAL

.

RECEIVEDCLERK'S

OFFICE

MAR 2 7 2007

Pollution

STATE OF

Control

ILLINOIS

Board

T •

•

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

.

Art cis Add eased to :

3/15/07

B.M .

PCB 2005-217

Ken Blouin

j 6446

Lakeway Drive

Monee, IL 60449

2

. Article Number

(Transfer from

service labeO

PS Form 3811,

February 2004

Domestic Return Receipt

r

A

. Signature

x

./5

B

. Received by

~ 6yR,rjnfed Name)

Is defvery address ditfere from item 1? 0 Yes

YES, enter deliveey a

below :

0 No

MAR 2 3 2007

i

•

Ice Type

rtffied- all

O

ress Mall

As""

Return Recall for Merchandise

0 insured MK

11 C.O .D .

4 Restricted Delivery?

. (Extra Fee)

7001 1140 00002 7469 0381

0 Agent

0 Addressee

M Yes

102595-02-M-154