Authentications Cover Letter

uthentications Office

(A/OPR/GSM/AUTH)

518 23

Street, N.W.

State Annex 1

Washington, DC 20520

Date: ___________________

Name: ____________________________________________________

Address: _________________________________________________

_________________________________________________

Daytime Telephone Number: ________________________________

Country Each Document will go to: ________________________

Fee is US currency of $8.00 for each document to be processed, made

payable to the U.S. DEPARTMENT OF STATE.

Number of Documents _______ X $8.00= $_______

Payment is enclosed: _______ Check# _______ or

_______ Money Order

Optional – Return documents by (please check if enclosed):

_______ Self-Addressed Stamped Envelope

_______ Overnight Delivery envelope of label (must have account #

pre-printed by the delivery company or have pre-paid postage stamp

from the delivery company)

Notes or Special Instructions:

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Parent category: Business