Appendix A 

Identification Statement Worksheet

All Periodicals publications must contain an identification statement. It must appear in easy-to-read type in one of the locations listed below. Check the box that indicates the location of the publication’s identification statement:

• One of the first five pages of the issue (count the cover only if it is marked as page 1).
• One of the last three nonadvertising pages (bound publications only).
• Masthead on the editorial page if the location of the editorial page is shown on the first page of the publication.
• The first page of the table of contents.

Please check that each of these elements appears in the identification statement and provide an example:

• Publication Title
• International Standard Serial Number (ISSN) or USPS Publication number if ISSN has not been assigned
• Issue Date (may be on cover)
• Statement of Frequency
• Issue Number (may be on cover)
• Subscription Price (optional)
• Publisher Name and Address of KOP
• Periodicals Postage Imprint “(Periodicals Postage Pending at ¼)”
• Change of Address Information (“POSTMASTER: Send address changes to...”)

Issue dates and numbers may appear on the spine edge of perfect-bound publications.

Note: If the publication does not contain a correct identification statement when the application is filed, a letter of intent showing the corrected identification statement as it will appear in the next printed issue of the publication must be attached to the application.

Sample Identification Statement (Pending Publication)

THE DAILY TIMES Issue 5 March 2001 (ISSN 7132-698X) is published daily except Sundays and federal holidays for $28 per year by Wright News Co.,
123 Maine Avenue, Washington, DC 20024-0001. Application to mail at Periodicals postage is pending at Washington, DC, and additional mailing offices. POSTMASTER: Send address changes to THE DAILY TIMES, PO Box 4, Boulder, CO 80302-0004.