Transcription of Request For Exception To Current/Proposed Delivery Mode ...
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Mail Delivery by the Current/Proposed method imposes an extreme physical hardship on the customer named below, (Domestic Mail Manual 508 ). A. CUSTOMER INFORMATIONName of CustomerDelivery Address CityStateZIP Code TelephoneEmailCustomer Signature (required)DateB. CURRENT TYPE OF Delivery (Check one)FFCurbline/Rural Box, Apartment BoxFFNeighborhood Delivery (Cluster Box)FFOther (please describe) _____ _____ C. TYPE OF Delivery REQUESTEDType of Delivery RequestedPhysical Reason for hardship Request (attach additional pages if needed) _____ _____ _____ D.
The above request for a hardship delivery exception is: FFGrantedEffective Date FFDenied, reason (use back if needed) _____ _____ Postmaster/Manager Signature Date District Manager Signature (Signature required only for denied requests.) Date Request For Exception To Current/Proposed Delivery Mode Due To Physical Hardship PS Form 1528, August 2019
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