I have this cover that took 8 days to go from Pakistan to Chicago.
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"P W Railway" was the State-owned railway in Pakistan from 1961 to 1974. Today it is just Pakistan Railways. The P W Railway marking looks like it was preprinted on the envelope, along with "ON PAKISTAN STATE SERVICE," which implies diplomatic usage. Then there's the boxed Registration handstamp - "R. L. No. 409" (or maybe 709). Then that very smudged Medical Office, etc. hand stamp. I think the purple handstamp is the return address (I see "Quetta" at the end - Quetta is the capital of Baluchistan province in Pakistan today). As for the "23/1/64," and the "No. 3/MED/" etc. notations, they look to me like something added by the recipient - a sort of "docketing." or something to do with the registration.
Anyways, I was curious what this might be worth (if anything).
Thanks,
Lucky