Fillable PS1500 Application for Listing and/or Prohibitory Order

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PS1500 Application for Listing and/or Prohibitory Order

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PS Form 1500, February 2009 (Page 1 of 3) PSN 7530-03-000-7374
Here's how to be placed on the Postal Service’s list of those not wishing to receive sexually oriented
advertisements through the mail.
If you are receiving unwanted sexually oriented advertisements coming through the mail to your home or business, there are
two Postal Service
®
programs you can use to help protect yourself (and your eligible minor children). Please read the
description of these programs on the reverse side of this page, then follow the instructions below for completing the
application.
There is something you can do about unwanted sexually oriented advertising in your mail.
If there is insufficient room to list all minor children, continue the list using page 2 of an additional PS Form 1500. Be sure
to sign the continuation page in the Authorization section.
Use the name and address by which you customarily receive mail.
The application must be legible and complete. (Please Print.)
Additional Instructions
Here's what to do if you wish to apply for a Prohibitory Order against a particular mailer whose advertising
offers to sell matter you consider erotically arousing or sexually provocative.
The prohibitory list provides a deterrent to the mailing of unsolicited sexually oriented advertisements to protected persons.
It would be a violation of your protected status if anyone makes such a mailing to you when your name and address have
been on the list more than 30 days.
When your application has been processed, we will send you information about the effective date of your listing and the
procedure for reporting a violation of your protected status.
Sign and date the application in the Authorization section and submit it to any Post Office. Keep pages 1 and 3 for
your records.
If applicable, complete the Information About Your Children section, providing full names and birth dates.
Complete the Application for Listing section on page 2 and 3.
Application for Listing and/or
Prohibitory Order
When your application has been processed, we will send you information about the effective date of your order and the
procedure for reporting a violation of your protected status.
Provide mailer information.
If applicable, complete the Information About Your Children section, providing full names and birth dates.
Sign and date the application in the Authorization section and submit it with the offending mailpiece (which must be
opened) to any Post Office™. Keep pages 1 and 3 for your records.
Complete the Application for Prohibitory Order section on page 2 and 3.
The Prohibitory Order program provides a deterrent to continued mailings by a specific mailer advertising a product or
service you consider erotically arousing or sexually provocative. Your Prohibitory Order would be violated if, 30 days or
more after receiving it, the mailer sends you any further mail.
PS Form 1500, February 2009 (Reverse of Page 1) PSN 7530-03-000-7374
If you are offended by receiving unwanted sexually oriented advertising in your mail, or are concerned about your minor
children being exposed to such advertising, there are two programs you can use to help protect yourself and your children.
Application for Prohibitory Order
Under the Pandering Advertisements Statute, 39 USC 3008, if you are the addressee of an advertisement, and consider the
matter (product or service) that it offers for sale to be "erotically arousing or sexually provocative," you can obtain a
Prohibitory Order against the mailer. You apply for the order by submitting the entire advertising mailpiece (the original, NOT
a photocopy) with a properly completed application (page 2 of this form). Please note: Even if there is an offer to sell a
product or service stated on the exterior of the mailpiece, if the piece has a sealed envelope, cover, or wrapper, please be
sure it is opened before you submit your application.
Minor children who has not attained the age of 19 years and residing with you may be included in the application. If the
addressee is a minor, you may apply for an order in your minor child's name. If the addressee is a deceased person whose
mail you are entitled to receive, you may apply for an order in the deceased's name. The order directs the mailer to make no
mailings whatsoever to anyone named in the order, effective on the 30th calendar day after the mailer receives it.
Application for Listing
Under the Sexually Oriented Advertisements Statute, 39 USC 3010, the Postal Service™ maintains a list of persons who
have informed us they do not wish to receive sexually oriented advertisements in their mail. When informing us, such
persons may also have their minor children who has not attained the age of 19 years, who are residing with them or are
under their care, custody, or supervision, included on the list. The statute defines the term "sexually oriented advertisement"
essentially as an advertisement depicting or explicitly describing human genitalia, sexual intercourse, sadistic or masochistic
acts, or related erotic subjects, and prohibits mailing such an advertisement to those whose names and addresses have
been on the list for more than 30 days.
You can be listed by filing a completed application (page 2 of this form). Because being added to the list does not depend on
having received a sexually oriented advertisement, do not submit mailpieces with your completed application. If you wish to
have a listing for more than one address, you must complete a separate application for each address. The list is provided to
mailers that subscribe to the USPS Prohibitory Order Listing service in an effort to have your name removed from their
mailing lists. However, it does not guarantee the removal of your name and address from all mailing lists.
Submitting Your Application
Submit completed applications to obtain the protection offered by one or both of these statutes to any Post Office™. When
your application has been processed, we will notify you of the effective date of your protected status and how to report any
violation.
Your obtaining the protection offered through these two programs makes sending prohibited mail to you unlawful. However,
it does not make such mailings physically impossible. If you receive an apparently violative mailpiece, contact your Post
Office or refer to your notification letter for instructions on submitting the piece as evidence for possible enforcement action.
Please contact any Post Office if, after reading these instructions, you still have questions about applying for the protection
offered by 39 USC 3008 and 39 USC 3010.
Privacy Act Statement
Postal Service Programs for Protection Against Unwanted Sexually Oriented Mail
Your information will be used to maintain a list of addressees that do not want sexually oriented advertising material mailed to
them, available for mailers to comply with statutory requirements; and to maintain records as necessary to provide protections
requested by an addressee against individual mailers under the Pandering Advertisement statutes. Collection is authorized by
39 USC 401, 403, 404, 3008, 3010, and 3403. Providing the information is voluntary, but if not provided, we may not process
your request. We do not disclose your information to third parties without your consent, except to facilitate the transaction, to
act on your behalf or request, or as legally required. This includes the following limited circumstances: to a congressional
office on your behalf; to financial entities regarding financial transaction issues; to a USPS® auditor; to entities, including law
enforcement, as required by law or in legal proceedings; and to contractors and other entities aiding us to fulfill the service
(service providers). For more information regarding our privacy policy visit us at www.usps.com
®
.
2.
I do not wish to have sexually oriented advertisements mailed to me or my children who have not attained the age of
19 years are listed below. Please add me/us to the list you maintain, under 39 USC 3010, of persons not wishing to
receive such advertisements. I understand that while this USPS Prohibitory Order Listing will be provided to mailers
that subscribe to your listing service in an effort to have me removed from their mailing lists, it does not guarantee the
removal of my name and address from all mailing lists.
Application for Listing (Mailpiece is not required for this option at this time)
I am the person entitled to receive mail to , the deceased addressee of the
attached mailpiece. Please issue the Prohibitory Order on behalf of the deceased addressee.
1a.
Application for Prohibitory Order (Submit the mailpiece with your application)
Printed Name (First, MI, Last)
City State
Address (Number, street, apt. or suite. no.,Post Office box no.)
The attached mailpiece, from the mailer identified below, offers for sale matter that I believe to be erotically arousing or
sexually provocative and therefore is a pandering advertisement. Under the provisions of 39 USC 3008, I request that a
Prohibitory Order be issued against the mailer and the mailer's agents or assigns.
If you initialed box 1, you MUST:
1.
I am the addressee of the attached mailpiece, and, if I have listed below an eligible child or children, I request that such
child or children (as well as I, myself) be protected by the Prohibitory Order.
I am the parent of
, the minor addressee of the attached mailpiece,
acting for such addressee to obtain a Prohibitory Order to protect just him or her. If a child or children of mine is/are
listed below, it is just in connection with the application under 39 USC 3010 that I am making by initialing box 2.
Please check only one as appropriate:
Information About You (Use the name and address by which you customarily receive mail)
PS Form 1500, February 2009 (Page 2 of 3) PSN 7530-03-000-7374
Application for Listing and/or
Prohibitory Order
Processing Center
Date of Birth
Children's Names
Last
First
Middle Initial
Month
Year
Day
Signature of Adult Completing Form Date
Information About Your Children (Defined as children who have not attained the age of 19)
Mailer's City, State, and ZIP+4
Mailer's Address (Number, street, apt. or suite. no., Post Office box no.)
Mailer's Name
Provide the following mailer information.
Attach the entire, opened mailpiece, and
Authorization
1b.
1c.
Initial box #1, or box #2, on both when
applying for this Prohibitory Order.
ZIP+4®
Accepting Postal Service™ Employee:
If the customer initialed box 1, answer the following questions:
If you answered NO to any of these questions, do not forward!
(Refer to DMM
®
508.8 or 508.9 as appropriate.)
Questions? For additional help, contact your district office or the Pricing and Classification Service Center.
Postmasters may not refuse to accept PS Form 1500 because the advertisement in question does not appear to be
erotically arousing or sexually provocative. Only the addressee may make that determination.
PS Form 1500, February 2009 (Reverse of Page 2) PSN 7530-03-000-7374
Please review the completed form when it is submitted by the customer and answer
the following questions:
Yes
Yes
Yes
No
No
No
Accepting Office Name
Name of Accepting Employee
Signature of Accepting Employee
Send all completed forms and mailpiece (if
applicable) NO LESS THAN weekly to:
Pricing And Classification Service Center
PO Box 1500
New York NY 10008-1500
1. Is the form signed and dated?
2. Is the form legible?
3. Is the signature the same as the printed name on the application?
4. Did the customer initial box 1 and/or box 2?
5. Answer questions 5 and 6 only if the applicant listed information
about children. If the children are listed in the Information About
Your Children section, are their birth dates included?
6. Are all children listed below the attained age of 19 years?
1. Is one of box 1a, 1b, or 1c checked?
2. Are the name and address of the mailer listed?
3. Did the customer give you the entire mailpiece (original, NOT a photocopy)?
4. Is the mailpiece opened?
Yes No
Yes No
Yes No
Yes No
Yes
No
Yes
No
Yes
No
2.
I do not wish to have sexually oriented advertisements mailed to me or my children who have not attained the age of
19 years are listed below. Please add me/us to the list you maintain, under 39 USC 3010, of persons not wishing to
receive such advertisements. I understand that while this USPS Prohibitory Order Listing will be provided to mailers
that subscribe to your listing service in an effort to have me removed from their mailing lists, it does not guarantee the
removal of my name and address from all mailing lists.
Application for Listing (Mailpiece is not required for this option at this time)
I am the person entitled to receive mail to , the deceased addressee of the
attached mailpiece. Please issue the Prohibitory Order on behalf of the deceased addressee.
1a.
Application for Prohibitory Order (Submit the mailpiece with your application)
Printed Name (First, MI, Last)
City State
Address (Number, street, apt. or suite. no., Post Office box no.)
The attached mailpiece, from the mailer identified below, offers for sale matter that I believe to be erotically arousing or
sexually provocative and therefore is a pandering advertisement. Under the provisions of 39 USC 3008, I request that a
Prohibitory Order be issued against the mailer and the mailer's agents or assigns.
If you initialed box 1, you MUST:
1.
I am the addressee of the attached mailpiece, and, if I have listed below an eligible child or children, I request that such
child or children (as well as I, myself) be protected by the Prohibitory Order.
I am the parent of
, the minor addressee of the attached mailpiece,
acting for such addressee to obtain a Prohibitory Order to protect just him or her. If a child or children of mine is/are
listed below, it is just in connection with the application under 39 USC 3010 that I am making by initialing box 2.
Please check only one as appropriate:
Information About You (Use the name and address by which you customarily receive mail)
PS Form 1500, February 2009 (Page 3 of 3) PSN 7530-03-000-7374
Application for Listing and/or
Prohibitory Order
Applicant -- Keep This Copy For Your Records
Date of Birth
Children's Names
Last
First
Middle Initial
Month
Year
Day
Signature of Adult Completing Form (Keep this copy, page 3, for your records) Date
Information About Your Children (Defined as children who have not attained the age of 19)
Mailer's City, State, and ZIP+4
Mailer's Address (Number, street, apt. or suite. no., Post Office box no.)
Mailer's Name
Provide the following mailer information.
Attach the entire, opened mailpiece, and
Authorization
1b.
1c.
Initial box #1, or box #2, on both when
applying for this Prohibitory Order.
ZIP+4®
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PS1500 Application for Listing andor Prohibitory Order

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Completed 2 October 2019

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