Justification for Non-substantive

Justification for Non substantive Change.docx

Evacuee Manifest and Promissory Note

Justification for Non-substantive

OMB: 1405-0211

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Justification for Non substantive Change


DS 5528, Block 89 Part 2- Promissory Note and Repayment Agreement:


# 4 -  I will include my name , date of birth, place of birth, and Social Security number with all correspondence, payments, and questions.  I will make payment to the Department of State, Accounts Receivable by credit/debit card, check or money order payable to Accounts Receivable Branch, PO Box 979005, St. Louis, MO 63197-9000. Send questions by mail or courier (DHL, FedEx, UPS, etc.) to: Accounts Receivable Branch, Comptroller and Global Financial Services 2010 Bainbridge Ave., North Charleston, SC 29405.  To make inquiries by telephone: From the U.S. or Canada, call: 1-800-521-2116 or internationally, call 843-746-0592. To make inquires by email, contact: [email protected]).



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWatkins, Pamela K
File Modified0000-00-00
File Created2021-01-15

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