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Unlted States Postal Service `Fos#iC'ffite: Note Mail Arrival Date & Time: <br /> Postage Statement -Standard Mail , t r i~ <br /> PermR Holder's Name and Address and Telephone Name and Address Telephone Name and Address of Individual or <br /> Email Address, If Any of Mailing Agent Organization for Which Mailing Is Prepared <br /> (liotherthan permit holden (If other than permR holder) <br /> /i r, ~t.{ ~7.~~t <br /> ~ V ~ ~ ~ ~i <br /> ~ ~ r~ P,~~ %f ~,~c~ssible Date 5~1~!t ~ <br /> ~ ~ ~ PO Bax 4'~g~'~d~ ~ ~ <br /> CAPS Cust. Ref. No. <br /> Customer No. Customer No. Customer No. <br /> Processing Category Marlin Date Federal A en Cost Code Statement Se No. No. and a of Containers <br /> Post Office L 9 } 9 cY 4• b'P <br /> of Mailing L~( jP~^Pa~ ? Letters ? CMM ~ y, <br /> _ Sacks <br /> Type of it Imprint ats ? NFM Weight of a Single Piece Total Pieces <br /> Postage ? Parcels -Machinable 1 ft. Letter Trays <br /> ?Preranceled Stamps ? Parcels - Inegular .+7/~~~ 2 ft. LetterTrays <br /> i~ ? Letters - Paitl as NFMs ~ _ _ _ _ pounds TT <br /> ~ ?Metered ? ECR Letters -Paid as ECR Flats EMM Letter Trays <br /> Flat Trays <br /> Permit # ~ ~ For Mal Enclosed within Another Class If Sacked, Based on Total Weight ~ pallets <br /> ? Periodicals <br /> ? Bountl Printed Matter? Library Mail ? Media Mail ? Farrel Post ? 725 prs ? 15 lbs. ? both Other <br /> For Automation Price Pieces, Enter Date of Address For Enhanced Carrier Route Price Pieces, Enter Date of For Enhanced Carrier Route Price Pieces, Enter Date of <br /> Matching nd CodlingG1 ~f Address Ma hing an/d Coding Carrier R~~te Seq n ing <br /> Move Update method: <br /> ? Ancillary service endorsement ? FASTforward ? NCOA~"k ? ACS ? Alternative method ? Multiple <br /> Parts Completed (Select all that apply) ~ A ~ B ~ C ~ D ~ E ~ F ~ G ~ H I ~ J ~ K ~ L ? S <br /> Total Postage (Add parts totals) ~ 0 <br /> Price at Which Postage Affixed (Check one) _ <br /> ~ ?Correct ?Lowest ?Neither pcs.x$ - Postage Affixed <br /> N Net Postage Due (Subtractposfage affrxed from total postage) <br /> O , <br /> for t9SPS {Jse'Only Addlfional Postage Payrilertt (Stale reason) - <br /> lZ <br /> _ . <br /> For postage affixed add additional payments to nef poslage due ` <br /> for permitrmprint.adoaddtttonalp~ycnentto totalpostage : _ TOf~~ Ad~USt@C1 POS"~~ge Af~IX~d <br /> Postmaster Report Total Postageld," ABC 130 ~O,ta) Aci~USted POStage PeCI7lIt'~i19~71f"Itlt. ' <br /> (Perinif fmPnnt Only) . <br /> The mailer's signature certifies acceptance of liability for and agreement ~ pay any revenue deficiencies assessed on this mailing, subject to appeal. If an <br /> 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 <br /> ~ agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or control. <br /> The mailer hereby certifies that all information furnished on this form is accurate, truthful, and complete; that the mail and the supporting documentation <br /> U 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 <br /> y_ 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 <br /> may be subject to criminal and/or civil penalties, including fines and imprisonment. <br /> U Privacy Notice: For information regarding our Privacy Policy visit www.usps.com. <br /> Signatu f Mailer or gent ~ ~ ' Printed e M I or Agent Signing Form Telephone <br /> _ <br /> ` 1NeigM tof a Single Piece Are pbstagefigures at left adfusted from ? Np ' <br /> ' O mailer's eritnes? If "YES state :reason . - <br /> ' .:..:pounds _ <br /> 8 <br /> 'Total Piece's: .Total 1Nei ht - ' <br /> Total Postage Round St ~~(1~ljylr ' <br /> ~.N E p Ci <br /> Presort;~>:nfication Performed? (Check one) ; ` . <br /> Yes ? tJo <br /> ~ <br /> I CERTIFI'thaf this mailing has beeri?nspeded. ; <br /> concerning: (1.) eligibility for postage ,rates clalmerl; ' <br /> (2) proper preparation (and presort where tequ)2d); Date Mailer'Notified onta B Mrtrals <br /> (3) proper completion of postage statement and ; G d y ( ) - <br /> (4) payment,of annual fee (if re'quired): '"_,~3. J <br /> r <br /> 1~erlfying Employee's Signature Pnnt Verifying Erriployee's Name Time AtJI <br /> _ <br /> P~. _ _ <br /> J <br /> <br /> PS Form 3602-R1, May 2008 (Page 1 of 11) PSN 7530-07-000-6209 This form and malting standards available on Postal Explorer at pe.usps.com. <br /> _ <br /> <br />