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Customer Phone (406) 608-0647 Post Office - PACIFIC GROVE Box Number(s) N/A
680 LIGHTHOUSE AVE

PAID:$53 online on 05/27/2024 Postal employee to provide.
PACIFIC GROVE, CA 93950
Online Application for Post Office™ Box Service
1. Will this service be used for: ☐ Business/Organization Use ☐
X Residential/Personal Use (Required)
2.Name of Business / Organization (If applicable)
3. Name of Person Applying (*Title if representing a business/organization)

Last Name First Name Middle Initial *Title
LOHR JAMES Z
4. Address (Number, Street, Apt. No., City, State, and ZIP Code™)
Number, Street, Apt. No.: 1325 DAVID AVE
City, State: PACIFIC GROVE, CA
ZIP Code™: 93950 Verify Initials
5. Telephone Number (include Area Code) 6. Email Address

( 406 ) 608-0647 [email protected]
7. Box Size Required: 1
8. Applicant must select and enter the ID number for two items of 9. List name(s) of all individuals, including members of a
valid identification listed below that must also be presented at business who will be receiving mail at this PO Box. All
Post Office. The first item must contain a photograph. The names listed must have verifiable ID upon request. *A
second item must be traceable to the bearer’s current physical parent or guardian may receive the mail of minors by
address listed on their application. Both items are required. listing their names (no ID is required).
Acceptable Photo IDs, please select one:
□ U.S. Driver’s License or State ID Card: Verify Initials Verify Initials
□ Passport, NEXUS, Matricula Consular, Alien Verify Initials Verify Initials

Registration Card or Certificate of Naturalization:
□ U.S.- Armed Forces, Government, University or Verify Initials Verify Initials

recognized Corporate ID card:
Acceptable Non-Photo IDs, please select one:

□ Current lease, mortgage, or deed of trust: Verify Initials` Verify Initials
□ Voter or vehicle registration card: Verify Initials Verify Initials
□ Home or vehicle insurance card: Verify Initials Verify Initials
Customer Note: The Postal Service® may consider it valid evidence that a person is authorized to remove mail from the box
if that person possesses a key or combination to the box.
SPECIAL ORDERS
10. Postmaster: The following named persons or representatives of the business/organization listed above are authorized to
pick up mail addressed to this (these) PO Box number(s). All names listed must have verifiable ID. (Continue on reverse side
if needed.)
Other Authorized Representative Verify Initials Other Authorized Representative Verify Initials
Date Paid Online Service Dates

05/27/2024 05/27/2024 through 08/31/2024
11. Signature of Applicant (Same as Item 3). The applicant certifies that all Number of Post Office Date
information furnished on this form is accurate, truthful, and complete. I understand keys issued: Stamp
that anyone who furnishes false or misleading information on this form or omits
information requested on this form may be subject to criminal and/or civil penalties,
including fines and imprisonment.
Privacy Notice: See reverse side of this form.

PS Form 1093, August 2019 (PSN 7530-02-000-7165)
Privacy Act Statement: Your information will be used to provide Post Office Box™ service. Collection is authorized by 39 U.S.C. 401,
403, 404, 407, and 411; 22 U.S.C. 214: 31 U.S.C. 7701. Supplying your information is voluntary, but if not provided, we may not be able to
provide this service to you. We do not disclose your information to third parties without your consent, except to act on your behalf or
request, or as legally required. This includes the following limited circumstances: to a congressional office on your behalf; to agencies and
entities to facilitate or resolve financial transactions; to a U.S. Postal Service® auditor; for law enforcement purposes, to labor
organizations as required by applicable law; incident to legal proceedings involving the Postal Service; to government agencies in
connection with decisions as necessary; to agents or contractors when necessary to fulfill a business function or provide products and
services to customers; for customer service purposes; to a federal, state, or local government agency for the performance of its duties; to
a person empowered to serve legal process; and to a foreign government agency for violations and alleged violations of law. Information
concerning an individual box holder who has filed a protective court order with the postmaster will not be disclosed except pursuant to
court order. For more information regarding our privacy policies visit www.usps.com/privacypolicy.

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Customer Phone (406) 608-0647 Post Office - PACIFIC GROVE Box Number(s) N/A

680 LIGHTHOUSE AVE

3. Name of Person Applying (*Title if representing a business/organization)

5. Telephone Number (include Area Code) 6. Email Address

□ Passport, NEXUS, Matricula Consular, Alien Verify Initials Verify Initials

□ U.S.- Armed Forces, Government, University or Verify Initials Verify Initials

Acceptable Non-Photo IDs, please select one:

□ Voter or vehicle registration card: Verify Initials Verify Initials

□ Home or vehicle insurance card: Verify Initials Verify Initials

Date Paid Online Service Dates

Privacy Notice: See reverse side of this form.

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