United States Postal Services
Postage Statement 
First-Class Mail
First-Class Mailand Priority Mail
Post Office:Note Mail Arrival Date & Time
Use this form for either First-Class Mail or Priority Mail. They may not be Combined.
Permit Holder's Name and Address and Email Address, if Any
Telephone
805-461-3457
Alexanders
P.O.Box 1684
Atascadero CA93423
P.O.Box 1684
Atascadero CA93423
CAPS Cust.Ref.No.__________________________
Customer.No. ___________________________
Name and Address of Mailing Agent(if other than permit holder)
Telephone
Alexanders
P.O.Box 1684
Atascadero CA93423
P.O.Box 1684
Atascadero CA93423
Customer No. ________________________
Name and address of individual
or organisation for which mail is prepared
or organisation for which mail is prepared
(if other than permit holder)
Customer No. ____________________
Post Office Of Mailing
ATASCADERO CA
Type of
Postage
Postage
Permit ImprintMetered
permit#
38
Processing Category
Letters
Flats
Automation Flats
Parcels
Letters Flats
Automation Flats
Parcels
Mailing Date
12/04/2008
Federal Agency Cost Code
Weight of a Single Piece
0.0210 Pounds
For Mail Enclosed Within Another Class Periodicals
Standard Mail
Bound Printed Matter Library Mail Media Mail Parcel Post
Bound Printed Matter Library Mail Media Mail Parcel Post
Statement Seq.No.
Total Pieces
14344
Total Weight
301.2240
For Automation Price Pieces, Enter Date of
Address Matching and Coding
Address Matching and Coding
11/28/2008
Move Update Method: Ancillary Service endorsement FASTforward
NCOALINK ACS Alternative Method Multiple
NCOALINK ACS Alternative Method Multiple
No.& types of containers
7-1' MM Trays
23-2' MM Trays
Parts Completed(Select all that apply) A B CDS{Part C only}Retail Commercial
A B CDS{Part C only}Retail Commercial
Total Postage(Add Parts Totals)
Price at Which Postage Affixed(check one)
Correct Lowest Neither
Correct Lowest Neither
0
__________
Pcs.x $ _____._____$0 = Postage Affixed
Net Postage Due(subtract postage affixed from total postage)
For USPS Use Only:Additional Postage Payment(state reason)
For postage affixed add additional payment to net postage due;
for permit imprint add additional payment to total postage.
for permit imprint add additional payment to total postage.
Total Adjusted PostageAffixed
Permit imprint only - check one
PM:Report totalPostage in AIC:
PM:Report totalPostage in AIC:
AIC 121 (First-Class Mail)
AIC 237 (Priority Mail)
AIC 237 (Priority Mail)
Total Adjusted Postage Imprint
$4,704.8500
$0.0000
$4,704.85
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 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 penalities, including fines
and imprisonment.
Privacy Notice: For information regarding our privacy policy visit www.usps.com.
Signature of Mailer or Agent
Printed Name of Mailing or Agent Signing Form
Telephone
Weight of a Single Piece
____ _____ . _____ _____ _____ _____ Pound
Total Pieces
Total Weight
Total Postage
Presort Verification Performed?(Check One)
Yes No
Yes No
I CERTIFY that this mailing has been inspected concerning: (1) eligibility for postage prices claimed; (2)Proper Preparation (and presort where required); (3)Proper completion of postage statements; and (4)Payment of annual fee (if required).
Verifying Employee's Signature.
Are Postage figures at left adjusted
from mailer's entries? If yes, reason:
from mailer's entries? If yes, reason:
Yes No
Date Mailer Notified
Contact
By (Initials)
Verifying Employee's Name
Time
AM
PM
PM
Round Stamp (Required)