Form 3600-R - Postage Statement - First-Class Mail Permit Imprint printable pdf download

United States Postal Service

Post Office Note Mail Arrival Time

Postage Statement — First-Class Mail

Permit Imprint

Permit Holder's Name and Address, and

Telephone

Name and Address of

Telephone

Name and Address of Individual or

Email Address If Any

Mailing Agent (If other

Organization for Which Mailing Is Prepared (If

than permit holder)

other than permit holder)

CAPS Cust. Ref. ID __________________________________________

Dun & Bradstreet No. _________________________

Dun & Bradstreet No. ______________________

Dun & Bradstreet No. ____________________

Number of Containers

Post Office of Mailing

Processing Category (DMM C050)

Mailing Date

Federal Agency Cost Code

Statement Seq. No.

Letters

Flats

Permit No.

Automation Flats (DMM C820)

Weight of a Single Piece

Total Pieces

Parcels

____ . ____ ____ ____ ____ pounds

For mail enclosed within another class:

Total Weight

Bound Printed

Library

Media

Parcel

Standard

Periodicals

Mail

Matter

Mail

Post

Total From Part A (On reverse)

For Automation Letters

Total From Part B (On reverse)

For Automation Flats

Total From Part C (On reverse)

For Nonautomation Letters, Flats, and Parcels

Total From Part D (On reverse)

For Automation and Nonautomation Cards

Total From Attached Form 3540-S

For Special Services and Other Fees

Postmaster: Report total

Total Postage

(Add lines above)

postage in AIC 121.

For USPS Use Only: Additional Postage Payment (State reason)

Postmaster: Report total

Total Adjusted Postage

(Add additional postage to total postage)

adjusted postage in AIC 121.

The signature of a mailer certifies that he or she will be liable for and agrees to pay,

For Enclosed Reply Pieces (Automation rates only): I

subject to appeals prescribed by postal laws and regulations, any revenue

certify that any letter-size cards or envelopes enclosed in the

deficiencies assessed on this mailing. (If this form is signed by an agent, the agent

pieces described above bear the correct facing identification

certifies that he or she is authorized to sign this statement, that the certification binds

mark (FIM) and barcode and meet automation compatibility

the agent and the mailer, and that both the mailer and the agent will be liable for and

standards in DMM C810.

agree to pay any deficiencies.)

For ZIP Codes (Presorted rates only): I certify that the ZIP

Codes appearing on the pieces described above have been

I hereby certify that all information furnished on this form is accurate, truthful, and

verified and corrected where necessary within 12 months of

complete; that this mailing meets all applicable CASS/MASS standards including but

the date of this mailing using a USPS-approved method.

not limited to those for completion of PS Form 3553 and address and barcode

accuracy; that the material presented qualifies for the rates of postage claimed; and that

For Updated Addresses (Presorted and automation rates

this mailing does not contain any hazardous materials prohibited by postal regulations.

only): I certify that the addresses appearing on the pieces

I understand that anyone who furnishes false or misleading information on this form

described above have been updated within 180 days of the

or who omits material information requested on the form may be subject to criminal

date of this mailing using a USPS-approved address update

sanctions (including fines and imprisonment) and/or civil sanctions (including multiple

method.

damages and civil penalties).

Signature of Permit Holder or Agent (Both principal and agent are liable for any postage deficiency incurred.)

Telephone

Weight of a Single Piece

Are figures at left adjusted from mailer's entries?

Yes

If "Yes," Reason

____ . ____ ____ ____ ____ pounds

Total Pieces

Total Weight

Total Postage

Round Stamp (Required)

Check One (If applicable)

Date Mailer Notified

Contact

By (Initials)

Presort Verification

Not Scheduled

Performed as Scheduled

I CERTIFY that this mailing has been inspected concerning: (1) eligibility for postage rate claimed; (2) proper preparation (and

presort where required); (3) proper completion of postage statement; and (4) payment of annual fee (if required).

Verifying Employee's Name

Verifying Employee's Signature

Time

3600-R,

PS Form

January 2001

(Page 1 of 2)

This form available at

Form 3600-R - Postage Statement - First-Class Mail Permit Imprint

Related Articles

Related forms

Related Categories