The Original Hobo Nickel Society, Inc.
12000 Sunset Ridge Drive
Ozawkie, KS 66070-6045

- Print and mail to one of the examiners below -

Submission will be reviewed by two OHNS examiners who will give independent opinions as to the quality of the carving (with explanation and/or observations), subject, and probably artist. A photograph of the coin will be taken to accompany the report. Originals of the report and photograph will be returned along with the coin to the owner and copies will be kept by (1) the examiner and (2) in the OHNS archives. Please fill out one form for each coin submitted and mail coin(s), form(s) and payment to one of the following examiners:


Bill Fivaz
P.O. Box 888660
Dunwoody, GA 30356-0660

Steve Alpert
P.O. Box 66331
Los Angeles, CA 90066-0331

Owner's Name:______________________________OHNS Membership #_______________________


Owner's value of coin (necessary for insurance):$___________________________________________

Fees: $15 per coin; 10 or more coins @ $12.50 ea.; $25 per coin for non-members
(Fee includes first class postage and $100 insurance per coin)

For ADDITIONAL INSURANCE and/or REGISTERED MAIL: please add $5.00 per coin

I understand the opinions rendered are strictly that, and are not a guarantee of value or authenticty.
It is, however, the best considered judgment by qualified specialists in the field; but, others may
reach different conclusions.

[ ] I authorize OHNS to use a photograph of this coin. [ ] I authorize OHNS to use my name (not address).


Signature of owner_______________________________________________ 


Please make all checks payable to: ORIGINAL HOBO NICKEL SOCIETY

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