Formulario Usps

United States Postal Service®

Application for Delivery of Mail Through Agent
See Privacy Act Statement on Reverse

1. 07/14/2012 Date

(mm/dd/yyyy)

In consideration of deliv ery of my orour (f irm) mail to the agent named below, the addressee and agent agree: (1) the addressee or the agent must not f ile a change of address order with the Postal Serv ice™ upon termination of theagency relationship; (2) the transf er of mail to another address is the responsibility of the addressee and the agent; (3) all mail deliv ered to the agency under this authorization must be prepaid withnew postage when redeposited in the mails; (4) upon request the agent must prov ide to the Postal Serv ice all addresses to which the agency transf ers mail; and (5) when any inf ormation required onthis f orm changes or becomes obsolete, the addressee(s) must f ile a rev ised application with the Commercial Mail Receiv ing Agency (CMRA). NOTE: The applicant must execute this f orm in duplicate inthe presence of the agent, his or her authorized employ ee, or a notary public. The agent prov ides the original completed signed PS Form 1583 to the Postal Serv ice and retains a duplicate completedsigned copy at the CMRA business location. The CMRA copy of PS Form PS 1583 must at all times be av ailable f or examination by the postmaster (or designee) and the Postal Inspection Serv ice. Theaddressee and the agent agree to comply with all applicable Postal Serv ice rules and regulations relativ e to deliv ery of mail through an agent. Failure to comply will subject the agency towithholding of mail f rom deliv ery until correctiv e action is taken. This application may be subject to v erif ication procedures by the Postal Serv ice to conf irm that the applicant resides or conductsbusiness at the home or business address listed in boxes 7 or 10, and that the identif ication listed in box 8 is v alid.

2. Name in Which Applicant's Mail Will Be Received for Delivery to Agent....