USPS PS - 1583 - 2004 Tio Cesar - Signed

United States Postal Service®
Application for Delivery of Mail Through Agent 1. Date

09/24/2021 (mm/dd/yyyy)
See Privacy Act Statement on Reverse
In consideration of delivery of my or our (firm) mail to the agent named below, the addressee and agent agree: (1) the addressee or the agent must not file a change of address order with
the Postal Service™ upon termination of the agency relationship; (2) the transfer of mail to another address is the responsibility of the addressee and the agent; (3) all mail delivered to the
agency under this authorization must be prepaid with new postage when redeposited in the mails; (4) upon request the agent must provide to the Postal Service all addresses to which the
agency transfers mail; and (5) when any information required on this form changes or becomes obsolete, the addressee(s) must file a revised application with the Commercial Mail
Receiving Agency (CMRA).
NOTE:
The applicant must execute this form in duplicate in the presence of the agent, his or her authorized employee, or a notary public. The agent provides the original completed signed
PS Form 1583 to the Postal Service and retains a duplicate completed signed copy at the CMRA business location. The CMRA copy of PS Form PS 1583 must at all times be available for
examination by the postmaster (or designee) and the Postal Inspection Service. The addressee and the agent agree to comply with all applicable Postal Service rules and regulations
relative to delivery of mail through an agent. Failure to comply will subject the agency to withholding of mail from delivery until corrective action is taken.
This application may be subject to verification procedures by the Postal Service to confirm that the applicant resides or conducts business at the home or business address listed in boxes
7 or 10, and that the identification listed in box 8 is valid.
2. Name in Which Applicant's Mail Will Be Received for Delivery to Agent. 3a.Address to Be Used for Delivery (Include PMB or # sign.)
(Complete a separate Form 1583 for EACH applicant. Spouses may complete #
LIM -
166098
and sign one Form 1583. Two items of valid identification apply to each spouse.
Include dissimilar information for either spouse in appropriate box.) 1 Aeropost Way / P.O. BOX
25645
AEROPOST INTERNATIONAL 3b. City 3c. State 3d. ZIP + 4
MIAMI FL 33206-3206
4. Applicant authorizes delivery to and in care of: 5. This authorization is extended to include restricted delivery mail for the
a. Name undersigned(s):
AEROPOST INTERNATIONAL 1.
cesar anaya gonzales
b. Address (No., street, apt./ste. no.) 2.
1 Aeropost Way 3.
c. City d. State e. Zip + 4

MIAMI FL 33206-3206
6. Name of Applicant 7a. Applicant Home Address (No., street, apt./ste. no)
cesar anaya gonzales manzana H1 lote 1 los jardines primera etapa
paradero celima, parque Huiracocha
8. Two types of identification are required. One must contain a photograph of 7b. City 7c. State 7d. ZIP + 4
the addressee(s). Social Security cards, credit cards, and birth certificates are San Juan de Lurigancho Lima Metropolitana
unacceptable as identification. The agent must write in identifying information. 7e. Applicant Telephone Number (Include area code)
Subject to verification. (
) -
5100000000
a. 9. Name of Firm or Corporation
40492966
(
Electoral ID ) 10a. Business Address (No., street, apt./ste. no)
b. 10b. City 10c. State 10d. ZIP + 4
(
) 10e. Business Telephone Number (Include area code)
Acceptable identification includes: valid driver's license or state non-driver's (
) -
identification card; armed forces, government, university, or recognized 11. Type of Business
corporate identification card; passport, alien registration card or certificate of
naturalization; current lease, mortgage or Deed of Trust; voter or vehicle
registration card; or a home or vehicle insurance policy. A photocopy of your
identification may be retained by agent for verification.
12. If Applicant Is a Firm, Name Each Member Whose Mail Is to Be Delivered. (All names listed must have verifiable identification. A guardian must list the names
and ages of minors receiving mail at their delivery address.)
13. If a CORPORATION, Give Names and Addresses of Its Officers 14. If Business Name of The Address (Corporation or Trade Name) Has Been
Registered, Give Name of County and State, and Date of Registration.
Warning: The furnishing of false or misleading information on this form or omission of material information may result in criminal sanctions (including fines and
imprisonment) and/or civil sanctions (including multiple damages and civil penalties).
15. Signature of Agent/Notary Public 16. Signature of Applicant (If firm or corporation, application must be signed by
officer. Show title.)
SIGN HERE/FIRME AQUI:
PS Form 1583, December 2004 (7530-01-000-9365)

USPS PS - 1583 - 2004 Tio Cesar - Signed

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United States Postal Service®

Application for Delivery of Mail Through Agent 1. Date

c. City d. State e. Zip + 4

b. 10b. City 10c. State 10d. ZIP + 4

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