Ps Form 6012-I - Operation Santa Letter (Individual) printable pdf download

Operation Santa Letter

(Individual)

A. Customer Information (Please print)

Name (Last, First, MI)

Address (Number, street, suite, etc.)

City

ZIP+4 ®

State

Telephone Number (Include area code)

Signature

Email Address

Privacy Act Statement: Your information will be used to fulfill your request to participate in the USPS

Operation Santa

Program and to adopt Operation Santa letters. Collection is authorized by 39 U.S.C. 401, 403, and 404. Providing the

information is voluntary, but if not provided, we may not process your request. We do not disclose your information

to third parties without your consent, except to facilitate the transaction, to act on your behalf or request, or as legally

required.This includes the following limited circumstances: to a congressional office on your behalf; to financial entities

regarding financial transaction issues; to a U.S. Postal Service auditor; to entities, including law enforcement, as required

by law or in legal proceedings; and to contractors and other entities aiding us to fulfill the service (service providers). For

more information regarding our privacy policy visit us at

B. Agreement to Adopt Operation Santa Letters from the United States Postal Service ®

The individual identified above agrees to the following for participation in this program:

Personal information contained in the selected letters will remain in the sole control of the U.S. Postal Service ® .

Responses to letters must be age-appropriate.

Responses to letters must be ready for mailing with the assigned numeric code placed in the return address

area. The Post Office ™ address will be used as the return address.

Responses to letters must be brought to the designated Post Office for payment of postage and to be

addressed to the child’s parent or guardian by a U.S. Postal Service employee.

Items returned as undeliverable or refused will be donated or destroyed by the U.S. Postal Service.

C. Postal Service™ Use Only

I certify that valid photo identification with matching name and home address has been presented and verified.

(If valid ID is not presented, the customer request must be denied.)

Yes (Identification presented and ID and address verified)

Verifying Employee’s Signature

Total number of letters provided for review. (Not to exceed 10)

6012-I

PS Form

, December 2017 (Page 1 of 2) PSN 7530-09-000-9209

Ps Form 6012-I - Operation Santa Letter (Individual)