United States Postal Service Fost Ofice: Note Mail Aubal Date & Time
7 . ‘Do Not Round-Stam|
Postage Statement - Nonprofit Standard Mail ,
[Permit Holder's Name and Address Telephone Name and Address of Telephone Name and Address of Mail Owner
and Email Address, if Any 502-587-3055 fovpenchedey 502-777-7241 (If other than permit holder)
KCADP. Farley Printing Co.
__| Pat Delahanty Sarah Farley
&| P.O. Box 3092 1014 South Sixth St.
g Louisville, Ky 40201-3092 Louisville, KY 40203-3320
mail@ farleyprintco.com
USPS Nonprofit Auth. No.
CAPS Cust RefNo. = SSSOSOSOSOSSSSOSOCCSCS USPS Nonprofit Auth. No
CRID 2884530 CRID 8222493 ICRID
PostOnice of Mailing Processing Category Mailers Mailing Date Federal Agency CostCode [Statement Seq, No. | No. and Type of Containers
Louisville, Ky Dy Letters (Catalogs |Apr 17, 2014 154751 Q Sacks
40221-0999 O Flats i gg
SSF Transaction # Total FoF Preces in 8 1ft Letter Trays
LD Marketing Parcels 8
[i] Permit imprint Mailing
rymecar D1 Parcels - Machinable 4 2ft Letter Trays
eee Cabrecanceled | parcels - irregular Weight ofa Single Piece | Combined Mailing | 1,430
Postage LI stamps Mixed Class 0 EMM Letter Trays
2 Metered ocmm 0,0469 pounds | 5 single Class Fetal welaht —_—-
= PPemt For Mall Enclosed within Another Class 67.0670 0 Flat Trays
w Periodicals | [ Mailpiece is a “alieis
s| 110 ound Printed M Library Mail [J Media Mail product sample. = _10.Rialle
[1 Bound Printed Matter [] Library Mail [] Media Mai a SaniBIee. 9 ota
For Automation Pieces, Enter Date of Address |For Carer Route Pieces, Enter Date of Address] For Carer Route Pieces, Enter Date of |For Pieces Bearing a Simplified Address Enter Date
Matching and Coding Matching and Coding Carrier Route Sequencing of Delivery Statistics File or Altemative Method
04/17/2014 04/17/2014
Move Update Method: C] Ancillary Service Endorsement [| NCOA “KT ACS [7 Alternative Method [] Multiple [] OneCode ACS [1] n/a Altemative Address Format
This isa Political Maling [TT Yes []No_ | This is Oficial electon Man __ [J Yes [No TL Letiersize or flat maliprece contains DVDICD or other disk
Parts Completed (Select all that apply) MA MB LIC DID DE DIF FIG OH Oi Dy Pit PIM CIS TINSA
1 Subtotal Postage (Add Parts Totals) $199.94
© 2 | Price at Which Postage Afixed (Check one). Complete ithe malling includes pieces bearing meteredIPC Postage or precanceled
£ stamps. []Corect [J Lowest [] Neither pes. x $. = Postage Affixed| ~
$/ 3 Incentive/Discount Flat Dollar Amount: a
a Fee Flat Dollar Amount: | +
5 | Permit # Net Postage Due (Line 1 +- Lines 2, 3, 4) $199.94
a ‘Additional Postage Payment (State reason)
& |For postage affixed, add additional payment to net postage due; ; =
a or permit imprint add additional payment to total postage. Total Adjusted Postage Affixed
Postmaster: Report Total Postage in AIC 125 5; z F
a
|(Permit imprint Only, Excluding Simplifed Addressing (EDDM) Total Adjusted Postage Permit Imprint
Postmaster: Report Total Postage in AIC 208 iy 5 if; i
(Simpified Addressing (EDDM), Permitimprint Only) _TOtal Adjusted Postage Simplified Addressing (EDDM)
Incentive/Discount Claimed: Type of Fee
S |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)(i)(I)
“3 | and 26 U.S.C. 513A); (3) the mailing if made by a voting registration official is required or authorized under the National Voter Registration Act of 1993; and (4) itwill agree to pay, subject io 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
i | certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibilty, knowledge, or control. The mailer hereby
B | cetiies that all information furnished on ths form is accurate, tutful and complete; thatthe mail and supporting documentation comply with all postal standards and that the mailing qualifies for the
35 [prices and fees claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. | understand that anyone who furnishes false or misleading information on ths form
G | rho omits information requested on this form may be subject to criminal andor civil penalties, including fines and imprisonment.
Privacy Notice: For information regarding our Privacy Policy visit_www.usps.com.
Signature of Maller or Agent Printed Name of Mailer or Agent Signing Form Telephone
9 J gent Signing y
Sarah Farley 502-777-7241
Weightora ‘Fre postage figures atleftagjusted from
Single Piece Pound mailer's entries? If yes, reason: Lives [No
| Total Preces [Total Weight 3
>see PAc
So “| Total Postage gs on
= vu
on q | Presort Verification Performed? _(irrequired) Round Stamp (Required) a B W
evegc Yes No Date Mailer Notified (Contact Payment Date 3)
yn Ei Q]| 1 CERTIFY that this mailing has been inspected for each item below if ° =
26 B| sequies: 3 3 7)
Ww S 4m | (1) eligibility for postage prices claimed; 27 oO
a $ 2 (2) proper preparation (and presort where required); By inital) Time AM g Oo
W ‘6 | (3) proper completion of postage statement; PM wa Sa
> F §| (4) payment of annual fee; and B FS
| _(5) sufficient funds on deposit (if required)
USPS Employee's Signature Print USPS Employee's Name
PS Form 3602-N1, January 2014 (131101) Facsimile by Bulk Mailer Business 5.8.0, Satori Software Inc., (206) 357-2900
Nonprofit Standard Mail
X PartA Check box at left if prices are populated in this section.
Automation Letters
Letters 3.3 0z. (0.2063 Ibs.) or less
Entry Price Category Price No. of Pieces PeEe Discount Total* Fee Total Total Postage
Al None 5-Digit $0.143
A2 None 3-Digit 0.161
A3 None AADC 0.161 295 47.495 0.2950 47.2000
A4 None Mixed AADC 0.183 287 52.521 0.2870 52.2340
AS DNDC 5-Digit 0.109
AG DNDC 3-Digit 0.127
AT DNDC AADC 0.127
A8& DNDC Mixed AADC 0.149
AQ DSCF 5-Digit 0.099
Al0| DSCF 3-Digit 0.117 656 76.752 0.6560 76.0960
All| DSCF AADC 0.117 145 16.965 0.1450 16.8200
Letters Over 3.3 0z. up to 3.5 oz
‘ Or ‘i a
Price Piece No.of Pieces Pound Pounds Subtotal Discount Total
Enty category Price A™OUNt pieces Subtotal Price PUPIS Subtotal Postage Totalt Fe T°! postage
Affixed
A12|None} 5-Digit /$0.004 $0.676|
A13|None| 3-Digit | 0.022 0.676|
Al4|None| AADC | 0.022 0.676]
Mixed
A15 | None AADC 0.044 0.676]
Al16 |DNDC| 5-Digit | 0.004 0.510]
A17 |DNDC| 3-Digit | 0.022 0.510]
A18 |DNDC| AADC | 0.022 0.510]
Mixed
A19 |DNDC AADC 0.044 0.510]
A20|DSCF] 5-Digit | 0.004 0.460|
A21/DSCF] 3-Digit | 0.022 0.460|
A22|DSCF}| AADC | 0.022 0.460|
For affixed postage mailings as described in DMM 243, compute and enter the price for each piece in the Amount Affixed column,
multiply by No. of Pieces and total in the Total column.
[a23] PartA Total (Add lines A1-A22)] 192.3500]
Full Service Intelligent Mail Option
[A24] DISPLAY ONLY Letters - Number of Pieces that Comply 1383 x $ 0.001 =| 1.383]
* May contain both Full Service Intelligent Mail and other discount - see Instructions page for additional information.
PS Form 3602-N2, January 2014 (131101) Facsimile by Bulk Mailer Business 5.8.0, Satori Software Inc., (206) 357-2900
Nonprofit Standard Mail
X PartB Check box at left if prices are populated in this section.
Nonautomation Letters
Machinable Letters 3.3 02. (0.2063 Ibs.) or less
Entry Price Category Price No. of Pieces PeEe Discount Total Fee Total Total Postage
Bl None AADC $0.173
B2 None Mixed AADC 0.191 25 4.715 4.7750
B3 DNDC AADC 0.139
B4 DNDC Mixed AADC 0.157
B5 DSCF AADC 0.128 22 2.816 2.8160
Nonmachinable Letters 3.3 02. (0.2063 Ibs.) or less
Entry Price Category Price No. of Pieces pocone Discount Total Fee Total Total Postage
B6 None 5-Digit $0.334
B7 None 3-Digit 0.427
B8 None ADC 0.458
BO None Mixed ADC 0.546
B10] DNDC 5-Digit 0.300
B11] DNDC 3-Digit 0.393
B12] DNDC ADC 0.424
B13] DNDC Mixed ADC 0.512
B14| DSCF 5-Digit 0.289
B15| DSCF 3-Digit 0.382
B16| DSCF ADC 0.413
Nonmachinable Letters Over 3.3 oz. but less than 16 oz.
r
Price Piece No.of Pieces Pound Pounds Subtotal Discount Total
Endy: Category Price our Pieces Subtotal Price Rounds Subtotal Postage Total Fee,]otal Postage
B17|None] 5-Digit |$0.140 $0.676|
B18|None] 3-Digit | 0.208 0.676|
B19|None| ADC 0.262 0.676|
Mixed
B20) None ADC 0.313 0.676)
B21|DNDC} 5-Digit | 0.140 0.510]
B22 |DNDC} 3-Digit | 0.208 0.510]
B23|DNDC} ADC 0.262 0.510]
Mixed
B24 |DNDC ADC 0.313 0.510]
B25 |DSCF| 5-Digit | 0.140 0.460|
B26 |DSCF| 3-Digit | 0.208 0.460|
B27|DSCF} ADC 0.262 0.460|
For affixed postage mailings as described in DMM 243, compute and enter the price for each piece in the Amount Affixed column,
multiply by No. of Pieces and total in the Total column.
Part B Total (Add lines B1-B27) 7.5910
PS Form 3602-N3, January 2014 (131101)
Facsimile by Bulk Mailer Business 5.8.0, Satori Software Inc., (206) 357-2900
In Copyright - Educational Use Permitted