Said he got it in change as a child. More than likely not real

I went to dinner with my mother a few years back. She pulled out a pack of $1 bills that she found somewhere at home and she decided to spend them for the dinner to get rid of them. Standing in line, out of the corner of my eye I happened to notice these bills looked a little odd. The next thing I noticed was at the top they said "SILVER CERTIFICATE". I made sure they weren't spent at face value.:bigeyes::eat:

 

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I am having problems finding a company that will slab the coin. The only one that looks promising is ANACS but I can't seem to download their submission form. Can anyone point me in the right direction? Or email me the submission form if they have it?

 

Email sent, could not attach form using Cointalk email, but if you reply to my email I'll be able to send you the form.

 

Thank you so much my email is mastershaketnj@gmail.com.

 

mastershaktnj has a copy of the ANACS submission form now.

 

His first problem was caring what people on the internet thought of him and his messed up coin...and it IS one messed up coin...