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 Ad

ed to

AC 200

21

David

346

Fr lin Street

5/3/07

B .

1

COMPLETE THIS SECTION ON DELIVERY

B

D Agent

DAddressee

I ad by (Printed Name)

C . Date of Delivery

C

1

4.1

/In

rely (

S- 1 a-o7

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

If YES, enter delivery address below

:

0 No

O=

IN AL

RECEIVEDCLERK'S

OFFICE

MAY 1

4

2007

Pollution

STATE OF

Control

ILLINOISBoard

Bement,'IL 61813

Ii

Ice type

Ifled Mall D Express Mail

Registered

0

Return Receipt for Merchandise

0 Insured Mall

0

C.O.D.

4

. Restricted Delivery?

(EMra Fee)

0 Yes

2 . Article Number

(Transfer

from service label)

7006 0100 0000 7374 7866

PS Form 3811, February 2004

Domestic Returnn Receipt

102595-02-M-1540