Ps Form 3602-R1 - Postage Statement - Standard Mail printable pdf download

United States Postal Service

Post Office: Note Mail Arrival Date & Time

Postage Statement - Standard Mail

Permit Holder's Name and Address and

Name and Address

Name and Address of Individual or

Telephone

Email Address, If Any

of Mailing Agent

Organization for Which Mailing Is Prepared

(If other than permit holder)

CAPS Cust. Ref. No.

Dun & Bradstreet No.

Processing Category

Mailing Date

Federal Agency Cost Code

Statement Seq. No.

No. and type of Containers

Post Office

of Mailing

Letters

CMM

Flats

Total Pieces

Type of

Weight of a Single Piece

Permit Imprint

Automation Flats (DMM 301.3)

Precanceled Stamps

Postage

____ . ____ ____ ____ ____

pounds

Parcels

Metered

Total Weight

Detached Address Lables?

Permit #

For Mail Enclosed within Another Class

If Sacked, Based on

Periodicals

(DMM 602.4)

Yes

Parcel Post

Bound Printed Matter

Library Mail

Media Mail

125 pcs

15 lbs.

both

For Enhanced Carrier Route Rate Pieces, Enter Date of

For Automation Rate Pieces, Enter Date of Address

Address Matching and Coding (DMM 708.3.3)

Carrier Route Sequencing (DMM 245/345/445.6.10.1)

Matching and Coding

(DMM 708.3.3)

____ ____ / ____ ____ / ____ ____ ____ ____

Parts Completed (Select all that apply)

Total Postage

(Add parts totals)

$0.00

Rate at Which Postage Affixed (Check one) (DMM 244, 344, 444)

Postage Affixed

_________

_____ . ______ =

pcs. x $

Neither

Correct

Lowest

(

Net Postage Due

Subtract postage affixed from total postage)

$0.00

For USPS Use Only: Additional Postage Payment

(State reason)

For postage affixed add additional payments to net postage due;

Total Adjusted Postage Affixed

for permit imprint add additional payment to total postage.

AIC 130

Postmaster: Report Total Postage in

Total Adjusted Postage Permit Imprint

(Permit Imprint Only)

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 rates 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

Weight of a Single Piece

Are postage figures at left adjusted from

Yes

mailer's entries? If "Yes" state reason.

____ . ____ ____ ____ ____ pounds

Total Pieces

Total Weight