Application To Mail At Nonprofit Standard Mail Rates printable pdf download

United States Postal Service

Application to Mail at

Nonprofit Standard Mail

Rates

Section A—Application (Please read section B on page 2 before completion.)

Part 1

(For completion by applicant)

The applicant named in item 5 must be the individual submitting the

All information entered below must be legible so that our records will

application for the organization and must be a responsible official of the

show the correct information about your organization.

organization. Printers and mailing agents may not sign for the organization.

The complete name of the organization must be shown in item 1.

No additional organization categories may be added in item 6. To be

The name shown must agree with the name that appears on all

eligible for the Nonprofit Standard Mail rates, the organization must

documents submitted to support this application.

qualify as one of the types listed.

A complete address representing a physical location for the

The applicant must sign the application in item 12.

organization must be shown in item 2. If you receive mail through a

Post Office™ box, show your street address first and then the box

The date shown in item 14 must be the date that the application is

number.

submitted to the Post Office.

No application fee is required. (All information must be complete and typewritten or printed legibly

1. Complete Name of Organization (If voting registration official, include title)

2. Street Address of Organization (Include apartment or suite number)

3. City, State, ZIP+4

Code

4. Telephone (Include area code)

5. Name of Applicant (Must represent applying organization)

6. Type of Organization (Check only one)

(09) Qualified political committee

(01) Religious

(03) Scientific

(05) Agricultural

(07) Veterans'

(Go to item 9)

(10) Voting registration official

(02) Educational

(04) Philanthropic

(06) Labor

(08) Fraternal

(Go to item 9)

Not all nonprofit organizations are eligible for the Nonprofit Standard Mail rates. DMM® 703.1 lists certain organizations (such as business leagues,

chambers of commerce, civic improvement associations, social and hobby clubs, governmental bodies, and others) that, although nonprofit, do not

qualify for the Nonprofit Standard Mail rates.

9. Has this organization previously mailed at the Nonprofit

Yes

7. Is this a for-profit organization or does any of the net

Yes

Standard Mail rates? (If `Yes,' list the Post Office locations

income inure to the benefit of any private stockholder

where mailings were most recently deposited at these rates.)

or individual?

8. Is this organization exempt from federal income tax? (If

10. Has your organization had Nonprofit Standard Mail

Yes

`Yes,' attach a copy of the exemption issued by the

rate mailing privileges denied or revoked? (If `Yes,'

Internal Revenue Service (IRS) that shows the section

list the Post Office (city and state) where the

of the IRS code under which the organization is

application was denied or authorization was revoked.)

exempt. Required if exempt. Do not submit State tax

11. Post Office (not a station or branch) where authorization requested

exemption information.)

and bulk mailings will be made (City, state, ZIP Code™)

Yes

Has the IRS denied or revoked the organization's

federal tax exempt status? (If `Yes,' attach a copy of

the IRS ruling to this PS Form 3624.)

Choose the IRS Section for your recognition of

exemption under 501(c):

3 Educational, Philanthropic, Religious, Scientific

19 Veterans

5 Agricultural, Labor

8 Fraternal

Other (See statement in item 6 above.)

I certify that the statements made by me are true and complete. I understand that anyone who furnishes false or misleading information on this form or

who omits material information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions

(including multiple damages and civil penalties). I further understand that, if this application is approved, a postage refund for the difference between the

regular Standard Mail and Nonprofit Standard Mail rates may be made for only mailings entered at regular Standard Mail rates at the Post Office identified above

while this application is pending, provided that the conditions set forth in Domestic Mail Manual 703.1 and 703.1.9 are met.

14. Date

12. Signature of Applicant

13. Title

Part 2

(For completion by postmaster at originating office when application filed)

1. Signature of Postmaster (Or designated representative)

2. Date Application Filed With Post Office (Round stamp)

3624,

PS Form

June 2006 (Page 1 of 3) PSN 7530-02-000-9014

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