Form 3575 - Usps - Change Of Address Template
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1If mailing the form below, put in envelope and address as follows (Remember to apply First Class postage):
“TO: POSTMASTER
United States Postal Service”
OFFICIAL MAIL FORWARDING CHANGE OF ADDRESS ORDER
OFFICIAL USE ONLY
Please PRINT items in 1-10 in blue or black ink. Your signature is required in item 9.
Zone /Route ID No.
1. Change of Address for:
2. Is This Move
Yes
No
Temporary?
Individual (item 5)
Entire Family (item 5)
Business (item 6)
Date Entered on Form 3982
M
M
D
D
Y
Y
3. Start Date:
M M D D Y Y
4. If TEMPORARY move, print date
M M D D Y Y
(ex. 02/27/08)
to discontinue forwarding
(ex. 03/27/08)
5a. LAST
Expiration Date
Name &
M
M
D
D
Y
Y
Jr./Sr./Etc.
5b. FIRST
Clerk/Carrier Endorsement
Name and
MI
6. If BUSINESS
Move, Print
Business Name
PRINT OLD MAILING ADDRESS BELOW: HOUSE/BUILDING NUMBER AND STREET NAME (INCLUDE ST., AVE., CT., ETC.) OR PO BOX
7a. OLD
Mailing
Address
7a. OLD
7b. For Puerto Rico Only: If address is in PR, print urbanization name, if appropriate.
APT or
Suite
7c. OLD
7d.
7e.
CITY
State
ZIP
PRINT NEW MAILING ADDRESS BELOW: HOUSE/BUILDING NUMBER AND STREET NAME (INCLUDE ST., AVE., CT., ETC.) OR PO BOX
8a. NEW
Mailing
Address
8a. NEW
8b. For Puerto Rico Only: If address is in PR, print urbanization name, if appropriate.
APT/Ste
or PMB
8c. NEW
8d.
8e.
CITY
State
ZIP
OFFICIAL USE ONLY
9. Print and Sign Name (see conditions below)
M M D
D
Y
Y
_________________
Print:
(ex. 01/27/08)
Sign:
0508
Visit to change your address online or call 1-800-ASK-USPS
PS FORM 3575 MAY 2008
(1-800-275-8777)
NOTE: The person signing this form states that he or she is the person, executor, guardian, authorized officer, or agent of the
person for whom mail would be forwarded under this order. Anyone submitting false or inaccurate information on this form is
subject to punishment by fine or imprisonment or both under Section 2, 1001, 1702 and 1708 of Title 18, United States Code.
PRIVACY NOTICE: The information you provide will be used to forward your mail to a new location. Collection is authorized
by 39 USC 404. Filing this form is voluntary, but we cannot forward your mail without it. We do not disclose your information,
except in the following limited circumstances: to government agencies or bodies as required to perform official duties; to
mailers, only if they already possess your old address; in legal proceedings or for service of process; to law enforcement as
needed for a criminal investigation; or to contractors who help fulfill the service.
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