CERTIFICATE OF SERVICE
I, the undersigned, certify that I have served on the date of ____________ the attached [describe document served] upon the following persons by [describe method of service, e.g., depositing the document in a U.S. Postal Service mailbox or delivering the document to a third-party commercial carrier], by the time of ____________, with proper postage or delivery charges prepaid:
[list persons served and the respective addresses at which they were served]
[signature]
[date]
Ill. Admin. Code tit. 35, pt. 101, app E, ILLUSTRATION B