Form 1583

United States Postal Service
Application for Delivery of Mail Through Agent

See Privacy Act Statement on Reverse
1. Date

In consideration 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 address order with the Postal Service upon termination of the agency relationship; (2) the transfer of
mail to another address is the responsibility of the addressee and the agent; (3) all mail delivered to the agency under this authorization must
be prepaid with new postage when redeposited in the mails; (4) upon request the agent must provide to the Postal Service all addresses to
which the agency transfers mail; and (5) when any information required on this form changes or becomes obsolete, the addressee(s) must file
a revised application with the Commercial Mail Receiving Agency (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 completed signed PS Form 1583 to the Postal Service and retains a duplicate completed signed copy at
the CMRA business location. The CMRA copy of PS Form PS 1583 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 applicable Postal Service rules and
regulations relative to delivery of mail through an agent. Failure to comply will subject the agency to withholding of mail from delivery until
corrective action is taken.
This application may be subject to verification procedures by the Postal Service to confirm that the applicant resides or conducts business at
the home or business address listed in boxes 7 or 10, and that the identification listed in box 8 is valid.
3a. Address to Be Used for Delivery (include PMB or # sign.)
2250 NW 114
TH
AVE. UNIT 1A SDQ
2. Name in Which Applicant's Mail Will Be Received for Delivery to Agent.
(Complete a separates Form 1583 for EACH applicant. Spouses may
complete and sign one PS Form 1583. Two items of valid identification apply
to each spouse. Include dissimilar information for either spouse in appropriate
box.)

3b. City
MIAMI
3c. State
FL
3d. ZIP + 4
33172
4. Applicant authorizes delivery to and in care of:
Document Command, Inc.

a. Name
E-BOX LOGISTICS
b. Address (No., street, apt./ste. no.) 2250 NW 114
TH
AVE. UNIT 1A
c. City
MIAMI
d. State
FL
e. ZIP + 4
33172-3652
5. This authorization is extended to include restricted delivery mail for
the undersigned(s)
NESTOR GARCIA
ROBERTO ROSALES
OTNIEL ALVIZA
WILLIAMS PANTOJA
SABINA PFLUCKER

6. Name of Applicant

7a. Applicant Home Address (No., street, apt./ste. no))

7b. City

7c. State

7d. ZIP + 4

8. Two types of identification are required. One must contain a photograph of the
addressee(s). Social Security cards, credit cards, and birth certificates are
unacceptable as identification. The agent must write in identifying information.
Subject to verification.

7e. Applicant Telephone Number (include area code)

a.
9. Name of Firm or Corporation

10a. Business Address (No., street, apt./ste. no)

b.
10b. City

10c. State

10d. ZIP + 4

10e. Business Telephone Number (include area code)

Acceptable identification includes: valid driver's license or state non-driver's
identification card; armed forces, government, university or recognized corporate
identification card; passport or alien registration card or certificate of naturalization;
current lease, mortgage or Deed of Trust; voter or vehicle registration card; or a
home or vehicle insurance policy. A photocopy of your identification may be
retained by agent for verification.

11. Type of Business

12. If applicant is a firm, name each member whose mail is to be delivered. (All names listed must have verifiable identification. A guardian must list the names
of minors receiving mail at their delivery address.)

13. If a CORPORATION, Give Names and Addresses of Its Officers

14. If Business name (corporation or trade name) has been registered, give
name of county and state, and date of registration.

Warning: The furnishing of false or misleading information on this form or omission of material information may result in criminal sanctions (including fines and
imprisonment) and/or civil sanctions (including multiple damages and civil penalties).
15. Signature of Agent/Notary Public

16. Signature of Applicant (If firm or corporation, application must be signed
by officer. Show title.)

PS Form 1583, December 2004 (Page 1 of 2) (7530-01-000-9365)
This form on Internet at www.usps.com

_______________________________________________________________________________
15/10/2013
Stalin Bladimir Garcia Calle Ramon Caceres #3, Ensanche Kennedy
Santo Domingo
05800246828
8095674193
Distrito Nacional
302184

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United States Postal Service

Application for Delivery of Mail Through Agent

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