Ps Form 1583 - Application For Delivery Of Mail Through Agent - Washington

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USPS Form 1583 Instructions
(for use on USPS for 1583 dated April 2004 – a more up-to-date Form might be available at
)
Box#
Today’s Date
1.
Your Name (We require that each person complete a separate 1583) Reminder, did we
2.
mention, each person needs a separate 1583, except minor children, who must still be
listed here! Please list ages of minor children
Leave Blank… we will complete.
3.
If not already inserted, write/type the following address:
4.
Eastlake Mail
2226 Eastlake Ave. E.
Seattle, WA 98102-3419
Yes or No (Restricted Delivery is mail ONLY YOU can sign for). This allows us to sign for
5.
deliveries made to your mailbox.
Your Name
6.
Your Home Address and Phone #. This must be a physical address.
7.
(*Note, if your home address does not match your ID, you will need to show proof of where you live.
This could be a utility bill, rent agreement, voter registration, etc.)
NOTARY MUST COMPLETE .
8.
You must provide the Notary Public two (2) of the following forms of identifications.
Valid driver’s license
Recognized Corporate ID
Utility bill
Valid state issued ID
Passport
Home or vehicle insurance
card
Armed Forces ID
Alien Registration card
Vehicle registration card
Government issued I
Current lease, mortgage, or
D
deed
Medical Insurance Card
ersity ID
Univ
Voter registration card
Medical Prescription Card
(DO NOT USE CREDIT CARD, SOCIAL SECURITY CARD, OR BIRTH CERTIFICATE)
If Business, the Name.
9.
Business Address. Not the Eastlake Mail address; your physical business address.
10.
Kind of Business.
11.
Name of everyone in business that receives mail. (Reminder, did we mention, each
12.
person needs a separate 1583) More than 5 names incur an additional charge for
services. Call us for details.
List Officers
13.
Where registered
14.
NOTARY SIGNATURE & SEAL
15.
(not necessary if this form is delivered to Eastlake Mail in person)
Signature of applicant (YOU)
16.

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