State Form 50196 (5-01)
To be used with State Form 3
Inter-Departmental Mailing Envelope Reuse Label Inter Securely attach to a used I-D Envelope with glue or by taping on all four sides. This label can Isides. also be printed on self-sticking label paper stock. Do not use staples. self-
Date
Deliver to
Agency / Rm #
Sent by
Agency / Rm #
RECYCLED PAPER