Part 112, page 106

Transcript

The scan is the source; the transcript is machine-generated from it.

AX FOR POST OFFICE USE ONLY

TYPE OF IDENTIFICATION (Driver's license, military identification, other; show identification number): a [illegible] J.C. [identification number]: 21461-36285 64903Y DATE BOX OPENED: 10-7-76 DATE BOX CLOSED: [REDACTED] BOX NO.: 425

APPLICANT PLEASE NOTE: Execution of this application signifies your agreement to comply with all postal rules relative to the renting and use of Post Office boxes.

NAME OF APPLICANT (Print or type): Charles A. [guess: Tuller]

NAME OF FIRM OR CORPORATION (If box is rented for use of either): [guess: ADVANCE] ASSOCIATES INC.

KIND OF BUSINESS: [guess: Radio mass Communications]

BUSINESS ADDRESS (No., street, city, state, and ZIP code): [illegible] TELEPHONE NO.: [illegible]

HOME ADDRESS (No., street, city, state, and ZIP code): [guess: None] [guess: present] TELEPHONE NO.: [guess: 836] [guess: 4400] [illegible] [guess: Italy Anchilla], Va x [guess: 433]

DATE OF APPLICATION: [illegible]

ADDRESSES VERIFIED BY: [signature - illegible] TELEPHONE NUMBERS VERIFIED BY: [illegible]

--- For Post Office Use Only ENTERED IN DIRECTORY INITIALS OF CARRIER: [illegible] BOX NO.: 425

THE FOLLOWING MUST BE COMPLETED AND SIGNED BEFORE P.O. BOX IS ASSIGNED SHOW NAME BY WHICH P.O. IS RENTED WHEN OTHER THAN NAME OF APPLICANT

DELIVER MAIL IN ACCORDANCE WITH INSTRUCTIONS CHECKED BELOW [ ] ALL EXCEPT SPECIAL DELIVERY IN BOX [X] ALL INCLUDING SPECIAL DELIVERY IN BOX [ ] ONLY MAIL ADDRESSED TO BOX IS TO BE PLACED IN IT. ALL OTHER MAIL TO BE DELIVERED AS ADDRESSED. [ ] OTHER INSTRUCTIONS (Explain)

SPECIAL DELIVERY MAIL ONLY (Deliver as checked below) [ ] DELIVER TO LOCAL RESIDENCE AT [ ] DELIVER TO LOCAL BUSINESS ADDRESS AT

NAMES OF PERSONS ENTITLED TO RECEIVE MAIL THROUGH BOX (If box is rented to a firm, include the full name of each of its members, whose mail is to be placed in box.) Charles A [guess: Tuller] [blank line]

HAVE READ ITEMS 1 THROUGH 6, ABOVE AND WILL COMPLY WITH THEM. (Signature of applicant): [signature - cursive, partially legible: Charles A. [guess: Tuller]]

PS FORM 1093 APPLICATION FOR POST OFFICE BOX Apr. 1971

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