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 .

1

. Article Addressed to

: 5/3/07 B .M .

AC

2007-021

Tim Walker

3710 Christmas Tree Road

Decatur, IL 62521

4

I

COMPLETE THIS SECTION ON DELIVERY

lure

ILV~'l I,

eceived by (Printed

Name)

D . Is delivery address

If YES, enter deliv

A&

4. Restricted Delivery? (Extra Fee)

tern 1?

ess below:

01

gent

0 Addresses

of Delivery

Yes

0 No

3

. Service Type

srtmed Mail 0

0 Registered

0 Return

r Merchandise

0

Insured Mail

0 C.O.D .

0 Yes

2 . Article Number

(Transfer from service label)

PS Form

3811,

February 2004

7006 0100 0000 7374 7873

Domestic Return Receipt

10259502-M-15401

RECEIVE

CLERK'S

OFFICE

r)

MAY 2 j 2001

Pollution

STATE OF

Control

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