Mailing Agent's (Printer or Consolidator) Name, Address, Telephone Number, and Address if Any. Printer/Consolidator Imprint Permit No.

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1 United States Postal Service Statement - Periodicals One Issue or One Edition Unless Used as a Consolidated Statement Publication Title and Owner or News Agent's Name Mailing Agent's (Printer or Consolidator) Name, Address, Telephone Number, and Address if Any Post Office: Note Mail Arrival Date & Time (Do Not Round-Stamp) Entry Post Office Name, State, and ZIP+4 Mailer CAPS Customer Ref. No. CRID Printer/Consolidator Imprint Permit No. CRID Mailing Applicable Parts Completed Statement for bundles/ Category (select all that apply) containers only Regular Nonprofit A B - E F (If Applicable) Classroom Science-of-Agriculture Publication No. Edition/Code Mailer's Mailing Date Processing Category Letters Issue Date Issue Frequency Statement Sequence No. Flats Parcels Weight of a Single Ride-Along piece 0. lb. For Automation Pieces, Enter Date of Address Matching and Coding Weight per Copy for Issue (Round off to 4 decimal Advertising Percentage in This places if necessary) Issue. pounds. % For Carrier Route Pieces, Enter Date of Address Matching and Coding Combined Mailing Mixed Class Single Class For Carrier Route Pieces, Enter Date of Carrier Route Sequencing No. of Addressed Pieces Excluding Addressed Supplements Consolidated Statement Yes No Number of Addressed Supplements In-County Outside-County Number and Type of Containers. (Enter total number of containers) Trays Sacks Pallets For pieces bearing a simplified address enter date of delivery statistics file or alternative method / / / / / / / / Part A - In-County s Part A (page 2) (Postmaster: Report total Part A postage in AIC 224) Part B - Outside-County Pound s Part C - Outside-County Piece s Part D - Outside-County Bundle s Part B (Page 3) Part C (Page 4) Part D (Page 5) Part E - Outside-County Sack/Tray/Pallet s Outside-County Part E (Page 6 &7) Subtotal Parts B, C, D, and E Preferred Discount - Nonprofit, Classroom, Limited Circulation, Limited Circulation Science of Agriculture (Add line B16, and parts C, D, and E s) X.05 (all others enter zero) Subtract the Preferred Discount from the Outside-County Part F - Outside-County Ride-Along and Repositionable Notes (Page 7) - = + Certification Owner or Agent's Name Owner or Agent's Signature Outside-County (Postmaster: Report total Outside-County postage in AIC 135) Add In-County and Outside-County The signature of the owner of the publication 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 owner of the publication and that the owner of the publication 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 owner of the publication 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 penalties, including fines and imprisonment. Privacy Notice: For information regarding our Privacy Policy visit Name and Telephone Number of Contact Person in Publisher's Office USPS Use Only To be completed in non-postalone! sites Post Office Computed Weight per Copy (Round off to 4 decimal places if necessary). pounds Time AM PM USPS Employee's Signature Print USPS Employee's Name (AIC AIC 135) Round Stamp (Required) Payment Date PS Form , January 2012 (Page 1 of 7) PSN This form and mailing standards are available on Postal Explorer at pe.usps.com. USPS Use Only To be completed in non-postalone! sites

2 Periodicals - One Issue or One Edition - In-County Part A In-County Pound Entry Subscriber or Requester Nonsubscriber or Nonrequester A1 DDU $0.145 A2 None A3 Pound (Add lines A1 and A2) Piece (Presort) Entry / Zone Presort Discount Addressed Pieces A4 Nonautomation $0.133 A5 Basic Automation Letters A6 Automation Flats A7 Nonautomation A8 3-Digit Automation Letters A9 Automation Flats A10 Nonautomation A11 5-Digit Automation Letters A12 Automation Flats A13 Basic A14 Carrier Route High Density A15 Saturation A16 Presort Subtotal (Add lines A4-A15) A17 Number of Addressed Pieces at DDU s A18 Piece Subtotal (A16 minus A17) Full Service Intelligent Mail Option A19 Number of pieces that comply x $0.001 = A20 Periodicals In-County Subtotal (Line A18 minus A19) Ride-Along (Must equal the number of copies in line A16, not number of addressed pieces) Addressed Pieces A21 Ride-Along Pieces Repositionable Notes (Must equal the number of copies in line A16, not number of addressed pieces) A22 Repositionable Notes Addressed Pieces A23 Other Subtotal(Add lines A21 and A22) Part A (Add lines A3, A20, and A23) Postmaster: Report in AIC 224 PS Form 3541, January 2012 (Page 2 of 7)

3 Part B Outside-County - Pound s For Nonprofit & Classroom: All commingled nonsubscriber or nonrequester copies over the 10% limit must pay regular prices & use a separate PS Form Advertising Pound s Entry Zone Subscriber or Requester Nonsubsc. or Nonreq. Advertising Reg Sci/Ag B1 DDU $0.135 $0.101 B2 DSCF B3 DADC B4 1 & B B B B B B B11 Subtotal (Add lines B1-B10) Nonadvertising Pound s minus Advertising equals Nonadvertising X Reg Sci/Ag B12 DDU (From B1) (From B1) $0.113 $0.113 B13 DSCF (From B2) (From B2) B14 DADC (From B3) (From B3) B15 All Others (From B4-B10) (From B4-B10) B16 Subtotal (Add lines B12-B15) Pound (Add lines B11 and B16) Nonadvertising Pound s - Alternate (Nonprofit and Classroom publications with 10% or less advertising, or other publications with 0% advertising.) Entry Zone Subscriber or Requester Nonsubsc. or Nonreq. Reg Sci/Ag B12 DDU $0.113 $0.113 B13 DSCF B14 DADC B15 All Others B16 Subtotal (Add lines B12-B15) Part B - Pound (Add lines B11 and B16) PS Form , January 2012 (Page 3 of 7) PSN

4 Part C Outside-County - Piece s Machinable Flats Level Level Addressed Pieces C1 Mixed ADC Barcoded $0.414 C2 Nonbarcoded C3 ADC Barcoded C4 Nonbarcoded C5 3-Digit Barcoded C6 Nonbarcoded C7 5-Digit Barcoded C8 Nonbarcoded Nonmachinable Flats and Parcels C9 Mixed ADC Barcoded (flats only) $0.580 C10 Nonbarcoded C11 ADC Barcoded (flats only) C12 Nonbarcoded C13 3-Digit Barcoded (flats only) C14 Nonbarcoded C15 5-Digit Barcoded (flats only) C16 Nonbarcoded Letters C17 Mixed ADC Barcoded $0.323 C18 Nonbarcoded C19 ADC Barcoded C20 Nonbarcoded C21 3-Digit Barcoded C22 Nonbarcoded C23 5-Digit Barcoded C24 Nonbarcoded Carrier Route & Firm Bundles C25 Basic $0.187 C26 High-Density C27 Saturation C28 Firm Bundle (Use "Addressed Pieces" to calculate postage) C29 Subtotal (Add lines C1 through C28) C30 Nonadv. % (100 minus adv.%) X # of Addressed Pieces (C29) X $ C31 Subtotal Outside County Piece s (Line C29 minus C30) Full Service Intelligent Mail Option C32 Number of pieces that comply x $0.001 = Part C (Line C31 minus C32) PS Form 3541, January 2012 (Page 4 of 7)

5 Part D Outside County - Bundle s Container Level Bundle Level Bundles D1 Mixed ADC $0.079 D2 ADC D3 Mixed ADC 3-Digit/SCF D4 5-Digit D5 Firm D6 ADC D7 3-Digit/SCF D8 ADC 5-Digit D9 Carrier Route D10 Firm D11 3-Digit/SCF D12 SCF/ 3-Digit 5-Digit D13 Carrier Route D14 Firm D15 5-Digit D16 CR/ 5-Digit Carrier Route D17 Firm Part D (Add lines D1-D17) PS Form , January 2012 (Page 5 of 7) PSN

6 Part E Outside-County - Sack and Tray s Outside-County - Sack/Tray s Container Level Entry Sacks/Trays E1 Origin NDC $0.437 E2 Mixed ADC Origin ADC E3 Sack/Tray Origin SCF E4 Origin Post Office/DMU E5 Origin NDC E6 Origin ADC E7 ADC Sack/Tray Origin SCF E8 Origin Post Office/DMU E9 Destination NDC E10 Destination ADC E11 Origin NDC E12 Origin ADC E13 3-Digit / Origin SCF E14 SCF Sack/ Origin Post Office/DMU E15 Tray Destination NDC E16 Destination ADC E17 Destination SCF E18 Origin NDC E19 Origin ADC E20 5-Digit/ Origin SCF E21 Carrier Route Origin Post Office/DMU E22 Sack/Tray Destination NDC E23 Destination ADC E24 Destination SCF E25 DDU E26 Part E Sack and Tray (Add lines E1-E25) PS Form 3541, January 2012 (Page 6 of 7)

7 Part E - Continued Outside-County - Pallet s Outside-County - Pallet s Container Level Entry Pallets E27 Origin NDC $3.365 E28 Mixed ADC Pallet Origin ADC E29 Origin SCF E30 Origin Post Office/DMU E31 Origin NDC E32 Origin ADC E33 ADC Pallet Origin SCF E34 Origin Post Office/DMU E35 Destination NDC E36 Destination ADC E37 Origin NDC E38 Origin ADC E39 3-Digit / Origin SCF E40 SCF Pallet Origin Post Office/DMU E41 Destination NDC E42 Destination ADC E43 Destination SCF E44 Origin NDC E45 Origin ADC E46 Origin SCF E47 5-Digit / Origin Post Office/DMU E48 Carrier Route Pallet Destination NDC E49 Destination ADC E50 Destination SCF E51 DDU E52 Part E Pallet (Add lines E27-E51) Part E (add lines E26 and E52) Ride-Along (Must equal the number of copies, not number of addressed pieces) F1 Part F Ride-Along and Repositionable Notes (Outside-County Only) Ride-Along Pieces Addressed Pieces $0.165 Repositionable Notes (Must equal the number of copies, not number of addressed pieces) Addressed Pieces F2 Repositionable Notes $0.015 Part F (Add lines F1 and F2) PS Form , January 2012 (Page 7 of 7) PSN:

8 Instructions Use this form for Periodicals mailings. Step 1: Complete Mailer and Mailing sections on page 1. List all containers in the Number and Type of Containers field. You must select either Yes or No under Consolidated Statement. Step 2: Before you complete the section, go to parts A through E and complete the part(s) that pertain to your mailing. Pieces that comply with the Full-Service Intelligent Mail option requirements are additionally reported on the line provided.the following information will help you determine which parts to complete: Parts A - In-County piece and pound prices. Parts B - Outside-County pound prices. Parts C - Outside-County piece prices. Parts D - Outside-County bundle prices. Parts E - Outside-County sack/tray/pallet prices. Parts F - Outside-County Ride-along and Repositionable Notes prices. Step 3: Complete only applicable part(s), as follows: 1. For In-County mailings, complete only part A. 2. For Outside-County mailings, complete applicable parts B through F. Step 4: Go to the Section on page 1. Add postage from Part box for each completed part. Bring these totals forward to front page and insert in appropriate box. For outside-county sack/tray/pallet prices, complete distribution section in order to determine Part E total. Add all parts together to get. Step 5: Read and sign the Certification section, including your telephone number. Attach all completed pages together to submit with the mailing. (Do not include blank pages.) Information: For more information on mailing standards, prices, and fees please go to Postal Explorer at pe.usps.com. PS Form 3541, January 2012 (Instructions)