SENDER

: COMPLETE THIS SECTION

GOMPLtIb IMIS StUIIVN UN utLlvcnr

∎ Complete items 1, 2, and 3. Also complete

Sig re

item 4 if Restricted Delivery is desired .

•

Print your nameand 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 Addressed to :

5/17/07

B.M .

AC

2007-049

Herman P . and Karen Meyers

5328 Staton Ridge Road

Belknap, IL 62908

;

I

A.

x

B. Received by (Printed Name)

l e .

∎

I

2 .Article

(

Number

(

Traps

rrans/erfrom service

IabdQ

7006 2760 0003 5423 6720

`PS Form 3811, February 2004

D. Is delivery address different from item 11

If YES, enter delivery address below :

0 No

L1 Ves

Ice Type

mad Mall 0 Egress Mail

Registered

O Retum Receipt for

0 Insured Mall

0

C.O .D

.

4

. Restricted Delivery? (Extra Fee)

Agent

ddressee

C . Dateof Delivery

e

,~ 61

Domestic Return . Receipt

1025

M-1540

i

0[?

RECEIVEDCLERK'S

OFFICE

MAY Z 9 2007

Pollution

STATE OF

Control

ILLINOISBoard

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