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

Operation Santa Letter (Organization)

A. Organization Information (Please print)

Organization Name

Contact Name (Last, First, MI)

ZIP+4 ®

Business Address (Number, street, suite, etc.)

City

State

Telephone Number (Include Area Code)

Email Address

B. Agreement to Adopt Operation Santa Letters from the U.S. Postal Service ®

The organization identified above represents to the U.S. Postal Service that it is one of the following: A nonprofit,

charitable organization, corporation, or firm, and that it:

1. Assumes full responsibility for transportation and distribution of Santa Letters.

2. Will keep a list of individuals who receive Santa Letter(s) and agrees that this list will not be sold or released to other

organizations or individuals and that the names and addresses on the list will not be used for any purpose other

than participation in the Operation Santa program. The list must include the name, address, telephone number, and

verification that proper ID (i.e., state or federal identification) was presented by each individual to whom letter(s)

were given. The list must be made available to the U.S. Postal Service and/or its agents upon request and must be

retained by the organization for a minimum of one (1) calendar year.

3. Will dispose of, by shredding, any unanswered Santa Letters.

4. Will not represent that it is acting as an agent of the U.S. Postal Service.

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

6. Will notify individuals that responses to Santa Letters must be:

a. Age-appropriate.

™

b. Ready for mailing using the Post Office

address for the return address and the assigned numeric code in the

return address area.

c. Brought to the designated Post Office. At the Post Office, they will give the Postal Service

employee the letter,

pay the appropriate postage, and let the employee address the letter to the child’s parent or guardian.

d. Informed that the U.S. Postal Service will donate or destroy items returned as undeliverable or refused.

I am authorized to execute and deliver this instrument on behalf of the organization.

C. Authorized Signature

Authorized Representative’s Name (Please print Last, First, MI )

Signature

Title (Please print)

Date (MM/DD/YYYY)

D. Postal Service Use Only

I certify that valid government photo identification and approval from organization were presented and verified.

(If valid ID and approval are not presented, the customer request must be denied.)

Yes (Check if identification was presented and verified)

Verifying Employee’s Signature

Total number of letters provided

Date (MM/DD/YYYY)

Customer ID# (if applicable)

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6012

PS Form

, December 2017, (Page 1 of 2) PSN 7530-09-000-9179

Ps Form 6012 - Operation Santa Letter (Organization)

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