Ps Form 3602-N1 - Postage Statement - Nonprofit Usps Marketing Mail printable pdf download

United States Postal Service

Post Office: Note Mail Arrival

Date & Time (Do Not Round-Stamp)

Postage Statement— Nonprofit USPS Marketing Mail

Permit Holder

Mailing Agent

Mail Owner

Name, Address, Email, Telephone

(If other than permit holder)

(If other than permit

Name, Address, Telephone

holder) Name, Address

USPS Nonprofit Auth. No.

CAPS Cust. Ref. No.

CRID

Post Office of Mailing

Mailer’s Mailing Date

Federal Agency Cost Code

Statement Seq. No.

For Automation Pieces,

No. & Type

Enter Date of Address

of Containers

Matching and Coding

Sacks

Type of Postage

Processing Category

Total # of Pieces

SSF Transaction #

Parcels–Machinable

in Mailing

For Carrier Route Pieces,

Permit Imprint

Letters

Parcels–Irregular

1 ft. Letter

Enter Date of Address

Flats

Precanceled Stamps

Trays

Matching and Coding

CMM

Total Weight

Permit #

Metered

Marketing Parcels

Catalogs

2 ft. Letter

For Carrier Route

Trays

For Mail Enclosed

Move Update Method

Weight of a Single Piece

Mailpiece is a

Price Pieces, Enter

Alternative Method

within Another Class

product sample

Date of Carrier Route

Ancillary Service

Multiple

EMM Letter

Sequencing

Bound Printed Matter

Endorsement

pounds

% Samples

Trays

OneCode ACS

Link

Library Mail

NCOA

Letter-size or flat mailpiece contains DVD/CD

For Pieces Bearing

n/a Alternative

Flat Trays

Periodicals

ACS

Address Format

or other disk.

a Simplified Address

Enter Date of Delivery

Media Mail

Pallets

Statistics File or

Combined Mailing

This is a Political Campaign Mailing

Yes

Alternative Method

Mixed Class

Single Class

Other

This is Official Election Mail

Yes

Parts Completed (Select all that apply):

NSA

Subtotal Postage (Add parts totals)

Price at Which Postage Affixed (Check one).

Correct

Lowest

Neither

Postage Affixed -

Complete if mailing includes pieces bearing metered/PC Postage or precanceled stamps.

pcs. x $

Incentive/Discount Flat Dollar Amount -

Fee Flat Dollar Amount +

Net Postage Due (Line 1 + / - Lines 2, 3, 4)

5 Permit #

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 125

Total Adjusted Postage Permit Imprint

[Permit Imprint Only, Excluding Simplified Addressing (EDDM)]

Postmaster: Report Total Postage in AIC 208

Total Adjusted Postage Simplified Addressing (EDDM)

[Simplified Addressing (EDDM), Permit Imprint Only]

Incentive/Discount Claimed:

Type of Fee:

The mailer’s signature certifies that: (1) the mailing complies with DMM 703; (2) the income derived from the sale of any products or services advertised in the mailing is not sub-

ject to the Unrelated Business Income Tax (UBIT) and any products and services advertised are substantially related to the nonprofit organization’s authorized purpose within the

meaning of 39 U.S.C. 3626(j)(1)(d)(ii)(I) and 26 U.S.C. 513(A); (3) the mailing if made by a voting registration official is required or authorized under the National Voter Registration

Act of 1993; and (4) it will agree to pay, subject to appeal, any revenue deficiencies assessed on this mailing. 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 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 Owner or Agent

Printed Name of Mailer or Agent Signing Form

Telephone

Weight of a Single Piece

Total Weight

Are postage figures at left adjusted from mailer’s entries?

Round Stamp (Required)

Payment Date

Yes

No If yes, reason:

pounds

Total Pieces