I CERTIFY,
1. I am an adult, 21 years of age, or over.
2. I understand that I have the right, as a law-abiding citizen, to receive for my own private use sexually explicit material.
3. I authorize and request the LIBRARY SERVICE, INC,, to mail the sexually oriented brochures advertising sexually explicit material.
4. I am not a law enforcement official, postal inspector or member of any censorship group.
5. I have not asked the Post Office Department to "protect" me from receiving sexually oriented advertisemetns or from receiving sexually explicit material. You have my permission to continue to mail to me such advertisements and material until you receive written instructions to the contrary, by registered mail.
DATED: THIS______DAY OF_____, 197___
SIGNATURE____________________________
1. I am an adult, 21 years of age, or over.
2. I understand that I have the right, as a law-abiding citizen, to receive for my own private use sexually explicit material.
3. I authorize and request the LIBRARY SERVICE, INC,, to mail the sexually oriented brochures advertising sexually explicit material.
4. I am not a law enforcement official, postal inspector or member of any censorship group.
5. I have not asked the Post Office Department to "protect" me from receiving sexually oriented advertisemetns or from receiving sexually explicit material. You have my permission to continue to mail to me such advertisements and material until you receive written instructions to the contrary, by registered mail.
DATED: THIS______DAY OF_____, 197___
SIGNATURE____________________________
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