Ps Form 3624 - About Usps Page 3
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3Postal Service™ Checklist for PS Form 3624,
Application to Mail at Nonprofit Standard Mail Prices
Name of Organization
The organization above provided the following evidence of eligibility for Nonprofit Standard Mail prices.
1. Nonprofit Status (Select at least one)
IRS letter of exemption from payment of federal income tax
Financial statement prepared by an independent auditor substantiating organization’s nonprofit status (statement must include balance
sheets, notes, etc.)
Place of Worship
2. Organization (One complete copy; check all that apply. Must select at least one.)
Articles of Incorporation
Articles of Association
Charter
Constitution
Enabling Legislation
Trust Indenture
Other (Explain):
3. Operation (Several samples of each; check types of information included with application)
Listing of activities for past 6 to
Bulletins
Financial statements
Brochures
12 months
Membership applications
Minutes of meetings
Newsletters
Organizational or other documents substantiating that the applicant is the state or national committee of the political party
A copy of the statute, ordinance or other authority establishing responsibility for voter registration
Other (Explain):
The name on all the documents presented as evidence must match the name on the application. If they do not match, please explain.
Postmaster: PostalOne! offices must enter the information from the application into the PostalOne! system.
Non-PostalOne! offices must mail the application and documentation to the Pricing and Classification Service Center.
.
I certify that the applicant has completed all the items on the application and that each item is legible
Signature of Postmaster (Or designated representative)
Date
Telephone (Include area code)
Post Office (City, state, ZIP Code™)
Date Application Returned to Organization for Correction
Date Application and Documentation Sent to Pricing and Classification
Service Center
3624,
PS Form
April 2012 (Page 3 of 3) PSN 7530-02-000-9014
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