16ol UNrr 35
Erica Nelson is getting married. She completed this change-of-oddress form, but she
made eight mistakes. Find the mistakes and write sentences with was supposed to and
wasn't supposed to. lnclude the number of the item that has the mistake.
1.. Item 1the waa auppoeed to check one box.
OR
1he waan't euppooed to check two boxee.
2.
3.
4.
u.s. tosids&6
CHANGE OF ADDRESS ORDFR T
Customer lnstructions: Complete ltems 1 thru I, Except ltem 8, ptease
PRINT all inform.tidh ih.t'din.
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l. Change of address tot (Check one) fl
tndividuat
EJEntke Famity I
Business
Month Day Year
2'startDate
rc io ioi 6i gi
b
II TEMPOFARY
addreSs. orint
Monln
3 date to dibcontinue ,
Day Yeat
toruardino
4.Pdn!Lasl Name or Name of Busin€ss rrl, than Chande ol Addrcss Odet
eacn)
EiRiIiCiAi
5. PdnlFirst Name ol Head of Household (include Jr, Sr, etc.). Leave Blank if the Change of Address Order is
for a business.
N!eiliaioini i
6. !rctOLD mailing address, number and strcel (if Puerto Rico, include urbanization zone)
2i6i iviAiri LiEi iRi0iAiDi i i i
Apt./Suite No.
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PO. Box No.
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H.FYHCR No.
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Rural Box/HCR Box No.
State
It,,l i n I
City
ot ut bl
zip Code
iiil-trioiNi
7.Elh!NEW Mailing address, number and sfieel (it Puerto Ri@, include urbanization zone)
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Apt./Suite No. PO. Box No. H.FyHCB No.
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RuEl BoTHCR Box No.
City
AiMiHiEiRisiT t-l
,
State Zip Code
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S.Signature (S# corditions on reverse)
Erica Neloon
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9. Date Signed
Month Day Year
PS Fom 3575, June 1991 f u.s.G.Po. 1992-309-315
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