This form contains 93 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Dispatch Totals and Signatures
Dispatching Clerk Month Text
Enter the month associated with the dispatching clerk’s certification/signature for this dispatch.
Total Articles Sent Number
Enter the total number of articles sent by this dispatch.
Postmaster Name/Signature (Dispatch) Text
Enter the dispatching postmaster’s name (or signature text) certifying the articles sent.
Max length: 2 characters
General
REGISTERS Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._1 Text
Lock or Seal Nos Text
Lock or Seal Nos Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._2 Text
17 Text
17 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._3 Text
18 Text
18 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._4 Text
19 Text
19 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._5 Text
20 Text
20 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._6 Text
21 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._7 Text
22 Text
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21 Text
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22 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._8 Text
23 Text
23 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._9 Text
24 Text
24 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._10 Text
25 Text
25 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._11 Text
26 Text
26 Text
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Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._12 Text
27 Text
27 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._13 Text
28 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._14 Text
29 Text
Office or ZIP of Origin. Use only for Jacket, Lock, or Seal Numbers. Not required for individual Reg. Nos._15 Text
30 Text
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POSTMASTER Text
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office named in postmark [1 Text
office named in postmark [2 Text
1 Text
2 Text
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3 Text
28 Text
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4 Text
29 Text
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5 Text
30 Text
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6 Text
POSTMASTER Text
Receiving Clerks Notes (Irregularities/Discrepancies)
Receiving Clerk Acknowledgement Text
Enter the receiving clerk’s acknowledgement text (such as name, initials, or signature) confirming receipt of the dispatch.
Max length: 2 characters
Receiving Clerk Notes (Irregularities/Discrepancies) Text
Provide detailed notes describing any irregularities or discrepancies observed upon receipt (e.g., missing items, damaged seals, mismatched numbers, or other issues).
Max length: 6 characters
Receiving Totals and Signatures
Postmaster (Receiving) Signature/Name Text
Enter the name or signature of the postmaster acknowledging receipt of the dispatch.
Max length: 2 characters
Total Articles Received Number
Enter the total number of articles received in this dispatch.
Receiving Clerk Signature Date Date
Enter the date on which the receiving clerk signed for the dispatch.
Register Entries 1-15 (Office or ZIP of Origin)
Register Entries 1–15 Office or ZIP of Origin Text
Enter the originating post office name or ZIP code for register entries 1 through 15 (used only for jacket, lock, or seal numbers). Fill only if 'Register Entries 1–15 Reg/Jacket/Lock/Seal Numbers' indicates Jacket/Lock/Seal numbers (not individual Reg. Nos.).
Max length: 15 characters
Depends on: Register Entries 1–15 Reg/Jacket/Lock/Seal Numbers
Register Entries 1-15 (Reg/Jacket/Lock/Seal Nos.)
Register Entries 1–15 Reg/Jacket/Lock/Seal Numbers Text
Enter the register, jacket, lock, or seal number for each of entries 1 through 15 in the register list.
Max length: 15 characters
Register Entries 16-30 (Office or ZIP of Origin)
Entries 16–22 Office/ZIP of Origin Text
Enter the originating post office name or ZIP code for register entries 16 through 22. Fill only if 'Register Entries 16–30 - Reg/Jacket/Lock/Seal Numbers' indicates Jacket/Lock/Seal numbers (not individual Reg. Nos.).
Max length: 7 characters
Depends on: Register Entries 16–30 - Reg/Jacket/Lock/Seal Numbers
Entry 23 Office/ZIP of Origin Text
Enter the originating post office name or ZIP code for register entry 23.
Entries 24–25 Office/ZIP of Origin Text
Enter the originating post office name or ZIP code for register entries 24 through 25.
Max length: 2 characters
Entries 26–28 Office/ZIP of Origin Text
Enter the originating post office name or ZIP code for register entries 26 through 28.
Max length: 3 characters
Entries 29–30 Office/ZIP of Origin Text
Enter the originating post office name or ZIP code for register entries 29 through 30.
Max length: 2 characters
Register Entries 16-30 (Reg/Jacket/Lock/Seal Nos.)
Register Entries 16–30 - Reg/Jacket/Lock/Seal Numbers Text
Enter the register, jacket, lock, or seal numbers corresponding to register entries 16 through 30.
Max length: 15 characters
Right Stub Receipt Details
Right Stub Received By Text
Enter the name or signature of the clerk/person who received the articles listed on the specified bill.
Right Stub Bill Number Text
Enter the bill number shown for this dispatch on the right stub receipt.
Right Stub Seal Number Text
Enter the seal number associated with this dispatch as recorded on the right stub receipt.
Top Header Mailing Identifiers
Bill Number Text
Enter the bill number for this dispatch.
Seal Number Text
Enter the seal number associated with this dispatch.
To (P.O./R.P.O. and Train No.) Text
Enter the destination post office or railway post office and the train number for this dispatch.