Ps Form 3602-Nz - Postage Statement - Nonprofit Standard Mail Easy-Nonautomation Letters Or Flats

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Post Office: Note Mail Arrival Date & Time

United States Postal Service

(Do Not Round-Stamp)

Postage Statement — Nonprofit Standard Mail

Easy-Nonautomation Letters or Flats

This form may be used only for a single nonautomation price mailing of identical-weight pieces. Use PS Form 3602-N for all other Nonprofit

Standard Mail mailings. Checklists and other tools for mailers are available on the Postal Explorer website at .

Permit Holders Name and Address and Email Address, if Any

Telephone

This is a Political Campaign Mailing

246462

Palm Beach State College

Yes

USPS Nonprofit Auth. No.

4200 Congress Avenue

Lake Worth, FL 33461

This is Official Election Mail

Yes

CRID

Post Office of Mailing

Mailer's Mailing Date

Permit No.

Federal Agency Cost Code

No. & Type of

Containers

1388

West Palm Beach, FL 33416

Sacks __________

Weight of a Single Piece

Mailpiece is a product

Processing Category

Permit Imprint

Trays

__________

Type of

sample

Precanceled Stamps

pound

Postage

. ____ ____ ____ ____

Letters

Flats

Pallets __________

Metered

Move Update Method:

Total Pieces

Total Weight

Ancillary Service Endorsement

OneCode ACS

NCOA

ACS

Alternative Method

Multiple

n/a Alternative Address Format

Link

Letter-size or flat mailpiece contains DVD/CD or other disk

Total Postage

$ 0.000

(Add parts Totals)

Price at Which Postage Affixed (Check one) Complete if the mailing includes pieces bearing metered/PC Postage or precanceled stamps.

Postage Affixed

Correct

Lowest

Neither

__________ pcs. x $ _________ . _________=

Permit #________

Net Postage Due

(Subtract postage affixed from total postage)

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)

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 subject 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.

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Signature of Mailer or Agent

Printed Name of Mailer or Agent Signing Form

Telephone

Print and sign by hand

Weight of a Single Piece

Are postage figures at left adjusted from

Yes

mailer's entries? If yes, reason:

____ ____ . ____ ____ ____ ____ pound

Total Pieces

Total Weight