Professional Documents
Culture Documents
Usps PS - 1583 - 2004
Usps PS - 1583 - 2004
ApplicationforDeliveryofMailThroughAgent
SeePrivacyActStatementonReverse
1.
Date 1/8/2015
(mm/dd/yyyy)
Inconsideration 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
addressorderwiththePostalServiceuponterminationoftheagencyrelationship(2)thetransferofmailtoanotheraddressistheresponsibilityoftheaddresseeandthe
agent(3)allmaildeliveredtotheagencyunderthisauthorizationmustbeprepaidwithnewpostagewhenredepositedinthemails(4)uponrequesttheagentmustprovide
tothePostalServicealladdressestowhichtheagencytransfersmailand(5)whenanyinformationrequiredonthisformchangesorbecomesobsolete,theaddressee(s)
mustfilearevisedapplicationwiththeCommercialMailReceivingAgency(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
completedsignedPSForm1583tothePostalServiceandretainsaduplicatecompletedsignedcopyattheCMRAbusinesslocation.TheCMRAcopyofPSFormPS1583
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
applicablePostalServicerulesandregulationsrelativetodeliveryofmailthroughanagent.Failuretocomplywillsubjecttheagencytowithholdingofmailfromdeliveryuntil
correctiveactionistaken.
ThisapplicationmaybesubjecttoverificationproceduresbythePostalServicetoconfirmthattheapplicantresidesorconductsbusinessatthehomeorbusinessaddress
listedinboxes7or10,andthattheidentificationlistedinbox8isvalid.
2.NameinWhichApplicant'sMailWillBeReceivedforDeliverytoAgent.
3a.AddresstoBeUsedforDelivery(IncludePMBor#sign.)
(CompleteaseparateForm1583forEACHapplicant.Spousesmay
#PTY 99879
completeandsignoneForm1583.Twoitemsofvalididentificationapplyto
thSt./P.O.BOX25207
7801NW37
eachspouse.Includedissimilarinformationforeitherspouseinappropriate
3b.City
3c.State
3d.ZIP+4
box.)
AirboxExpress,S.A.(PANAMA)
4.Applicantauthorizesdeliverytoandincareof:
a.Name
AirboxExpress,S.A.(PANAMA)
b.Address(No.,street,apt./ste.no.)
7801NW37thSt./P.O.BOX25207
c.City
d.State
e.Zip+4
DORAL
FL
331666503
DORAL
FL
331666503
5.Thisauthorizationisextendedtoincluderestricteddeliverymailforthe
undersigned(s):
1.JuanArvalo
2.
3.
4.
6.NameofApplicant
JuanArvalo
7a.ApplicantHomeAddress(No.,street,apt./ste.no)
VaBrasil,edif.moniti,Apartamento1E
7b.City
7c.State
8.Twotypesofidentificationarerequired.Onemustcontainaphotograph
Panama
Panam
oftheaddressee(s).SocialSecuritycards,creditcards,andbirth
7e.ApplicantTelephoneNumber(Includeareacode)
certificatesareunacceptableasidentification.Theagentmustwritein
identifyinginformation.Subjecttoverification.
(
)60306183
9.NameofFirmorCorporation
a.
Pasaporte
10a.BusinessAddress(No.,street,apt./ste.no)
7d.ZIP+4
(035947585
b.
10b.City
10c.State
10d.ZIP+4
10e.BusinessTelephoneNumber(Includeareacode)
(3966109)
Acceptableidentificationincludes:validdriver'slicenseorstatenondriver's 11.TypeofBusiness
identificationcardarmedforces,government,university,orrecognized
corporateidentificationcardpassport,alienregistrationcardorcertificate
ofnaturalizationcurrentlease,mortgageorDeedofTrustvoteror
vehicleregistrationcardorahomeorvehicleinsurancepolicy.A
photocopyofyouridentificationmayberetainedbyagentforverification.
12.IfApplicantIsaFirm,NameEachMemberWhoseMailIstoBeDelivered.(Allnameslistedmusthaveverifiableidentification.Aguardianmustlistthe
namesandagesofminorsreceivingmailattheirdeliveryaddress.)
13.IfaCORPORATION,GiveNamesandAddressesofItsOfficers
14.IfBusinessNameofTheAddress(CorporationorTradeName)Has
BeenRegistered,GiveNameofCountyandState,andDateofRegistration.
Warning:Thefurnishingoffalseormisleadinginformationonthisformoromissionofmaterialinformationmayresultincriminalsanctions(includingfines
andimprisonment)and/orcivilsanctions(includingmultipledamagesandcivilpenalties).
15.SignatureofAgent/NotaryPublic
16.SignatureofApplicant(Iffirmorcorporation,applicationmustbesigned
byofficer.Showtitle.)
PSForm1583,December2004(7530010009365)
SIGNHERE/FIRMEAQUI: