Ps Form 3602-R1 - Postage Statement - Standard Mail

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United States Postal Service
Post Office: Note Mail Arrival Date & Time
(Do Not Round-Stamp)
Postage Statement - Standard Mail
Permit Holder's Name and Address and
Name and Address
Telephone
Name and Address of Mail Owner
Telephone
Email Address, if Any
of Mailing Agent
(If other than permit holder)
(If other than permit holder)
CAPS Cust. Ref. No.
CRID
CRID
CRID
Post Office of Mailing
Processing Category
Mailer's Mailing Date
Federal Agency Cost Code
Statement Seq. No.
No. and Type of Containers
Letters
____ Sacks
Flats
SSF Transaction #
Permit Imprint
Total # of Pieces in Mailing
Marketing Parcels
Type of
____ 1 ft. Letter Trays
Parcels - Machinable
Postage
Precanceled Stamps
Weight of a Single Piece
Parcels - Irregular
Combined Mailing
____ 2 ft. LetterTrays
Total Weight
CMM
Metered
Mixed Class
0
Catalogs
__ . __ __ __ __ pounds
Single Class
____ EMM Letter Trays
Permit #
For Mail Enclosed within Another Class
Periodicals
Mailpiece is a product sample.
____ Flat Trays
Bound Printed Matter
Library Mail
Media Mail
% Samples
For Automation Pieces, Enter Date
For Carrier Route Pieces, Enter Date
For Carrier Route Price Pieces, Enter
____ Pallets
For Pieces Bearing a Simplified Address Enter
Date of Carrier Route Sequencing
of Address Matching and Coding
of Address Matching and Coding
Date of Delivery Statistics File or Alternative Method
____ Other
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / __ __ / ___ ___ ___ ___
Link
Ancillary Service Endorsement
Move Update Method:
NCOA
ACS
Alternative Method
Multiple
OneCode ACS
n/a Alternative Address Format
This is a Political
Yes
No
No
This is Official Election Mail
Letter-size or flat mailpiece contains DVD/CD or other disk.
Yes
Campaign Mailing
Parts Completed (Select all that apply)
A
B
C
D
E
F
G
H
L
M
S
NSA
Subtotal Postage
1
(Add Parts Totals)
Price at Which Postage Affixed (Check one). Complete if the mailing includes pieces bearing metered/PC Postage or precanceled stamps.
2
-
Postage Affixed
Correct
Lowest
Neither
__________ pcs. x $ _________ . _________=
3
-
Incentive/Discount Flat Dollar Amount:
4
+
Fee Flat Dollar Amount:
5
Permit #________
Net Postage Due
(Line 1 +/- Lines 2, 3, 4)
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
AIC 130
Total Adjusted Postage Permit Imprint
(Permit Imprint Only, Excluding Simplified Addressing (EDDM))
AIC 208
Postmaster: Report Total Postage in
Total Adjusted Postage Simplified Addressing (EDDM)
(Simplified Addressing (EDDM), Permit Imprint Only)
Incentive/Discount Claimed: ____________________________
Type of Fee: ____________________________
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 that 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.
Privacy Notice: For information regarding our Privacy Policy visit
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
0
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
3602-R1,
PS Form
TBD 2016 (Page 1 of 14) PSN 7530-07-000-6209
This form and mailing standards are available on Postal Explorer at .

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