Ps Form 3600-Ez - Postage Statement - First-Class Mail-Easy Nonautomation Letters, Cards, Or Flats

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Post Office: Note Mail Arrival Date & Time
United States Postal Service
(Do not Round-Stamp)
Postage Statement—First-Class Mail-Easy
Nonautomation Letters, Cards, or Flats
Use this form for First-Class Mail.
Permit Holder's Name and Address and
Telephone
Post Office of Mailing
Permit #
Weight of a Single Piece
Email Address, if Any
0
__ . ___ ___ ___ ___ pound
Permit Imprint
Fed. Agency Cost
Number and Type of Containers
Type of
Precanceled Stamps
Code
Postage
Sacks __________
Metered
Trays
__________
Mailer's Mailing Date
Statement Seq. No.
Pallets __________
Processing Category
Total Pieces
Total Weight
Letters (Including Postcards)
Flats
Move Update Method:
OneCode ACS
Ancillary Service Endorsement
CRID
ACS
Alternative Method
Multiple
n/a Alternative Address Format
NCOA
Link
Number of
Category
Presort Level
Price
Total Postage
Pieces
B1. Presorted
x
$0.293
Postcards Eligible
for Postcard Prices
B2. Single-Piece
x
0.34
B3. Presorted
x
This is a Political Campaign Mailing
Letters
Yes
No
B7. Nonpresorted
x
B14. Presorted
x
This is Official Election Mail
Flats
Yes
No
B15. Single-Piece
x
Total Postage
(Add Parts Totals)
Price at Which Postage Affixed (Check one). Complete if the mailing includes pieces bearing metered/PC Postage or precanceled stamps.
Postage Affixed
Correct
Lowest
Neither
__________ pcs. x $ _________ . _________=
Permit # ________
Net Postage Due
(Subtract postage affixed from total postage)
Additional Postage Payment (State reason)
For postage affixed add additional payment to net postage due;
Total Adjusted Postage Affixed
for permit imprint add additional payment to total postage.
Postmaster: Report Total Postage in
Total Adjusted Postage Permit Imprint
AIC 121
(Permit imprint only)
The mailer's signature certifies acceptance of liability for and agreement to pay any revenue deficiencies assessed on this mailing, subject to
appeal. If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the mailer and that the mailer is bound by the
certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their
responsibility, knowledge, or control. The mailer hereby certifies that all information furnished on this form is accurate, truthful, and complete; that
the mail and the supporting documentation comply with all postal standards and the mailing qualifies for the prices and fees claimed; and that the
mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or misleading information
on this form or who omits information requested on this form may be subject to criminal and/or civil penalties, including fines and imprisonment.
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Signature of Mailer or Agent
Printed Name of Mailer or Agent Signing Form
Telephone
Weight of a Single Piece
Are postage figures at left adjusted from
Yes
No
mailer's entries? If yes, reason:
____ ____ . ____ ____ ____ ____ pound
Total Pieces
Total Weight
Round Stamp (Required)
Total Postage
Payment Date
Presort Verification Performed? (If required)
Yes
No (Check one)
I CERTIFY that this mailing has been inspected for
Date Mailer Notified
Contact
each item below if required:
(1) eligibility for postage prices claimed;
(2) proper preparation (and presort where required);
(3) proper completion of postage statement;
By (Initials)
Time
AM
(4) payment of annual fee; and
PM
(5) sufficient funds on deposit (if required)
Print USPS Employee's Name
USPS Employee's Signature
3600-EZ
PS Form
, January 2014 PSN 7530-07-000-6220
This form and mailing standards are available on Postal Explorer at .

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