Planilla Usps Venezuela

United States Postal Service® 1.
Date
Application for Delivery of Mail Through Agent
See Privacy Act Statement on Reverse
05-19-2024
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 changeof
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 PS Form 1583 for EACH applicant. Spouses may complete 2240 N.W., 114th Ave., Unit ZOOM-,
and sign one PS Form 1583. Two items of valid identification apply to each 3b. City 3c. State 3d. ZIP + 4®
spouse. Include dissimilar information for either spouse in appropriate box.) Miami FL 33192-4176
4. Applicant authorizes delivery to and in care of:

a. Name
E-BOX LOGISTICS
5. This authorization is extended to include restricted delivery mail for the
b. Address (No.,street, apt./ste. no.) undersigned(s):
2240 N.W., 114th Ave., Unit ZOOM-,
c. City d. State e. ZIP + 4
Miami FL 33192-4176
6. Name of Applicant
7a. Applicant Home Address (No., street, apt./ste. no)
NIORKYS DIANNELY MEDINA SIFONTES
8.Two types of identification are required. One must contain a photograph of
the addressee(s). Social Security cards, credit cards, and birth certificates are
unacceptable as identification. The agent must write in identifying information. 7e. Applicant Telephone Number (Include area code)
Subject to verification. 04265916436
a. 9. Name of Firm or Corporation
b. 10a. Business Address (No., street, apt./ste. no)
Acceptable identification includes: valid driver's license or state non-driver's 10e. Business Telephone Number (Include area code)
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 10b. City 10c. State 10d. ZIP + 4
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 of
minors receiving mail at their delivery address.)
14. If business name (corporation or trade name) has been registered, give name
13. If a CORPORATION, Give Names and Addresses of Its Officers
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).
16. Signature of Applicant (If firm or corporation, application must be signed by
15. Signature of Agent/Notary Public officer. Show title.)
NIORKYS DIANNELY MEDINA SIFONTES
This form on Internet at www.usps.com®
PS Form 1583, December 2004 (Page 1 of 2) (7530-01-000-9365) IP Address:190.97.250.7
Email:niorkysmedina7@gmail.com

Planilla Usps Venezuela

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United States Postal Service® 1.

4. Applicant authorizes delivery to and in care of:

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