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POST OFFICE DEPARTMENT
PERMIT NO.
STATEMENT OF MAILING MATTER WITH PERMIT IMPRINTS
MAILER: Prepare in duplicate, completing all items by typewriter, pen or indelible pencil.
357
NUMBER OF
POST OFFICE
RECEIPT NO.
SACKS
CARTONS
OUTSIDE
BUNDLES
1st-Letters,
3rd-Circulars and
3rd-Books or cata-
written matter,
2nd-Newspapers
and magazines
other printed matter,
logs of 24 pages
4th-Parcel post, books,
merchandise, printed
post cards.
entered as
merchandise less
or more, seeds,
second-class mail.
than 16 ozs.
etc., less than 16 ozs.
matter, 16 ozs. or
more.
NAME AND ADDRESS OF PERMIT HOLDER
(Include ZIP Code)
TELEPHONE NO.
Check here when mailing is by authorized nonprofit organization
(Section 134.5 P.M.)
great western ian
YES
Mailer (other than authorized nonprofit organization) must
47NO
check here whether his total mailings made at bulk third-
class rates at all post offices, under any name, for the cur-
rent calendar year, exceed 250,000 pieces.
Weight of a single piece.
OZS.
Number of pieces in a pound. (For third-class
SIGNATURE OF PERMIT HOLDER OR AGENT
matter mailed at bulk rates. )
16
Bryant
Total number of PIECES in mailing.
15 62
NAME AND ADDRESS OF INDIVIDUAL OR ORGANIZATION FOR WHICH MAIL-
ING IS PREPARED (If other than permit bolder)
Total number of POUNDS in mailing.
97. 6
Rate chargeable on each (check one)
POUND
PIECE is
3.8
TOTAL COMPUTED POSTAGE $ 5 9. 36
POD Form
July 1969
3602
Source: https://www.industrydocuments.ucsf.edu/docs/mtnh0227

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