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a 'United ztates Postal Service A TRUE COPY CERTIFICATION ON LAST PAGE Request to Pay Postage Refunds to Presenter of Mail J . K . BARTON , CLERK INDIAN RIVER COUNTY (Name of Customer) (hereinafter "the customer') hereby requests the United States Postal Service to accept requests for postage refunds submitted by Address N ' Mail Inc . (Name of Presenter) ( hereinafter "the presenter") for postage refunds on the mail of the customer, and toIpay refunds found to be due on such mail to the presenter, as specified below. 1 . This request applies to all mail of the customer, and on which the customer has paid postage , that is deposited with the Postal Service by the presenter. This request does not apply to mail that is deposited with)the Postal Service by persons or entities other than the presenter. 2. For all mail covered by this request, the presenter shall have the exclusive authority to submit to the Postal Service requests for postage refunds , and to receive payment of any such refunds that are determined to be owing because the amount of postage applied to the mail by the customer is in excess of lawful. rates . RVquests for refunds on such mail may be submitted only at the time of mailing , in accordance with, the procedures established in the Domestic Mail Manual. 3 . The Postal Service assumes no responsibility for maintaining records on the-arnount of refunds paid to the presenter pursuant to this request, or for the eventual disposition of any such refunds between the customer and the presenter. These are matters of private contractual agreement between the presenter and) the customer . 4 . This request will remain in force until the Postal Service receives written`- notification from the customer that this request is • revoked . i 5 . The submission of this request is not required by the Postal Service for the deposit of the customer's mail . This request will , however, permit the Postal Service to accept requests for refunds , made by the presenter on behalf of the customer, pursuant to a voluntary agreement between the customer and the presenter. JOSEPH A . BAIRD (Name) COUNTY ADMINISTRATOR (Title) I am duly authorized on behalf of the customer in making this request , and agree to all the terms and conditions of this request on_ b ��.QhP rimtnmpr . P. r 4;ip f LORIDA °°e ° eo ° e ° . '4 00 ° ° ° : :."' iAN RIVER COUNTY ��e°° ° 9°2 ° �•% ..9iS IS TO CERTIFY THAT THIS IS �a�p' TRUE AND CORRECTCOPYOF e� SIE ORIGINAL ON FILE IN THIS ere g FFICE • : : R • e V REYK . BART , C a °�00 / J P — D.C . °e ° 04 71r co (Signature and Date ) WARNING : The furnishing of false information on this form may result in a fine of not more than $ 10 , 000 or imprisonment of not more than 5 years , or both . ( 18 U . S . C : 1001 ) PS Form 8096 , June 1998