Ps Form 3602-N - Postage Statement

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3541
3600
3602
3605
3608
N
P
PN
PR
R
10/97
United States Postal Service
Postage Statement — Standard Mail (A)
(Nonprofit Only) — Permit Imprint
MAILER: Complete all items by typewriter, pen, or indelible pencil. If you need a receipt, prepare in duplicate.
Processing Category
USPS Authorized Mailing ID Code(s)
Post Office of Mailing
Mailing Date
Letters (DMM C050)
Flats (DMM C050)
Permit No.
Statement Sequence No.
Automation Flats
(DMM C820)
Machinable Parcels
Permit Holder’s
Telephone
Receipt No.
Prepared Under DMM (Check all that apply)
(DMM C050)
Name and Address
M610 (Letters, flats, parcels)
Irregular Parcels (DMM C050)
(Include ZIP Code)
Number of Containers (Fill in all that apply)
M610 (Upgradable letters)
M620 (Enhanced Carrier Route)
1-Ft.
2-Ft.
2-Ft.
Total Ltr.
MM Trays_______ MM Trays_______ EMM Trays_______ Trays_______
M810 (Automation letters)
Flat
N/A
M820 (Automation flats)
Trays_______
Sacks_______
Pallets_______
Other_______
If Sacking, Based On
Customer No. __________________
Weight of a
__.__ __ __ __
(Dun & Bradstreet)
Single Piece
125 pieces
15 pounds
Both
pounds
Authorized nonprofit rates?
Total Pieces
Total Weight
Name and Address of Mailing Agent (If other
CAPS Cust. Ref. ID
(DMM E670)
than permit holder)
Yes
No
________________________
Name and Address of Organization for Which Mailing Is
Prepared (If other than permit holder)
Authorized nonprofit
rates? (DMM E670)
Customer No. __________________
Customer No. __________________
Yes
No
(Dun & Bradstreet)
(Dun & Bradstreet)
For Nonprofit automation rate letter-size (DMM C810) or flat-size pieces (see DMM C820)
Part A
$
weighing .2085 lb. (3.3362 oz.) or less, go to Part A on reverse of this form.
For Nonprofit nonautomation rate pieces (DMM C050) weighing .2085 lb. (3.3362 oz.) or less,
Postage
$
Part B
go to Part B on reverse of this form.
(From
For Nonprofit Enhanced Carrier Route rate pieces (DMM C050) weighing .2084 lb. (3.3348 oz.)
reverse
or less, go to Part C on reverse of this form.
$
Part C
side)
For Nonprofit Enhanced Carrier Route rate pieces weighing more than .2084 lb. (3.3348 oz.),
or Nonprofit rate pieces weighing more than .2085 lb. (3.3362 oz.) but all less than 1.0 lb.
$
Part D
(16.0 oz.), go to Part D on reverse of this form.
Additional Postage Payment (State reasons)
No. Pieces
Rate/Fee Per Pc.
=
$
Single-Piece Rate
Nonstandard Surcharge
Special Service (Specify)
x $ ._______
Is applicable bulk per piece rate affixed to each piece? (Form 3602-PN required)
Total Postage
$
Yes
No
For Enclosed Reply Pieces (Automation rates only): I certify that all business reply, courtesy reply, or metered reply letter-size cards or envelopes,
enclosed in the pieces described above, bear the correct facing identification mark (FIM) and barcode under DMM C810.
For ZIP Codes (Nonautomation rates only): I certify that the ZIP Codes appearing on the pieces described above have been verified and corrected
where necessary within 12 months of the date of this mailing using a USPS-approved method.
The signature of a mailer certifies that: (1) the mailing does not violate DMM E670; (2) only the mailer’s matter is being mailed; (3) this is not a cooperative mailing with
other persons or organizations that are not authorized to mail at Nonprofit Standard Mail rates at this office; (4) this mailing has not been undertaken by the mailer on
behalf of or produced for another person or organization not authorized to mail at Nonprofit Standard Mail rates at this office; (5) the mailing, if made by a voting
registration official, is required or authorized by the National Voter Registration Act of 1993; and (6) it will be liable for and agrees to pay, subject to appeals prescribed
by postal laws and regulations, any revenue deficiencies assessed on this mailing, whether due to a finding that the mailing is cooperative or for other reasons. (If this
form is signed by an agent, the agent certifies that it is authorized to sign this statement, that the certification binds the agent and the nonprofit mailer, and that both the
nonprofit mailer and the agent will be liable for and agree to pay any deficiencies.)
The submission of a false, fictitious, or fraudulent statement may result in imprisonment of up to 5 years and a fine of up to $10,000 (18 USC 1001). In addition, a civil
penalty of up to $5,000 and an additional assessment of twice the amount falsely claimed may be imposed (31 USC 3802).
I hereby certify that all information furnished on this form is accurate and truthful, that this mailing meets all applicable CASS/MASS
standards for address and barcode accuracy, and that the material presented qualifies for the rates of postage claimed.
Signature of Permit Holder or Agent (Both principal and agent are liable for any postage deficiency incurred.)
Telephone
Single-Piece Weight
Are figures at left adjusted from mailer’s entries?
Yes
No
pounds
If "Yes," Reason
Total Pieces
Total Weight
Total Postage
Check One
Date Mailer Notified Contact
By (Initials)
Round Stamp (Required)
Presort Verification
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 required annual fee.
Signature of Weigher
Time
AM
PM
Financial Document — Forward to Finance Office
3602-N,
PS Form
October 1997

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