◆ SpookStack

cry STAL SERVICE APPLICATION FOR VEU@BERY OF MAIL THROUGH AGENT yer in consideration of delivery of my or our mai! to the agent named below, the addressee and agent agree that: (1) the Postal Service will not forward my or our mail on a change of address order upon termination of this agency relationship; (2) the forwarding or return of my or our mai) is the responsibility of the agent; and (3) all mail, including tetters and other first class mail, delivercd to the agent under this authorization must be prepaid with new postage when redeposited in the mails. NOTE: This application must he executed in duplicate by applicant in the presence of the agent or his authorized employee, A signed copy will be kept on file by the agent in such manner that it is at all times available for examination by postal represcntatives, TO: « Postmaster 2. MAIL ADDRESSED TO (Name, address and ZIP code) yey ac +t ( - ai ~ i a oj 2S g3°™ CUr 4, NAME OF APPLICANT (Print or type) 5, NAME OF FIRM OR CORPORATION 6 Ki U: ESS PERSOAA | 9. if address is a FIRM, name cach member whose mail is to be BDA. KS BIS 31 AAR 02671 1T#E70 @ REFERENCE (Name, address ond ZiF code) ‘ 3, DELIVER TO AND IN CARE OF /Name, address and ZIP code of agent} 4a, HOME ADDRESS (Number, Street and ZiP Code} yy : ; ‘ i 4 es 7 5a. BUSINESS A. Street and ZIP Code} 8. ffa CORPORATION, give names and addresses of its officers oy 10. REFERENCE (Name, address and 21P code} od 1. 1F BUSINESS NAME OF THE ADDRESS (Corporation or Trade Name) HAS BEEN REGISTERED, GIVE NAME OF COUNTY AND STATE, AND DATE OF REGISTRATION, . 2, SIGNA E OF AGENT De Bet mee co Fag . oie ‘of ee PAN rig ey Re a ior ae ates, f Fil ok AP Tt Ns Et Oe z Pe Ne EE se a VA. 13. SIGNATURE OF APPLICANT {if firm or cosporation, application must be signed by officer. Show title} PP SA ia tale al os re