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 it space permits

.

COMPLETE THIS SECTION ON DELIVERY

B .,,,dqqqeceived

by (Printed Name)

(ri

(i2 n1.'r,'CA

A . Sig ure

~

)

X

Et

Agent

EI Addressee

4 Restricted Delivery? (Extra Fee)

0

Yes

1 . Article Addressed to :

4 (19 (0 7 B . .

PCB 2005-191

Steven D . Grimm

Grimm Law Office

I P.O . box 632

1209 S

. Morrison Ave .,

Collinsville, IL 62234

2 Article Number

(Tmnsferfrom service label) 7006 0100 0000 7374 7705

PS

Form 3811,

February 2004

Domestic Return Receipt

D . Is delivery address different from item 1? 0 Ye

If YES, enter delivery address below:

O No

mice type

riffled Mall

CI Express Mall

Registered

0 Return Receipt for Merchandise

EI Insured Mall

O

C.O.D .

102595-02-M-1540

ORIGINAL

RECEIVEDCLERK'S

OFFICE

MAY 0 2 2007

Pollution

STATE OF

Control

ILUNOIS

Board