2009-1x1, 2009 U.S. National Christmas Seals Sheet, R10-CSCS-4-01, VF, MNH. Never folded, shipped flat.
Issued 2009 by the American Lung Association (ALA). Images of Snowmen, Reindeer, Bear, and Santa. Sheet of 56 (8x7) without gift tags, margin on 4 sides, "Fighting for Air" in the bottom margin. Dated 2009 with "R10-CSCS-4-01 in bottom margin. Seal size: 17x24mm. Silver margin scans much darker than actual color. R10-CSCS-4-01 on bottom margin.
History of Christmas Seals on the reverse of sheet.
Christmas Seals are also known as TB Seals, and are usually classified as Charity Seals, or Cinderella Stamps.