R1 SUPPLEMENT 6509.11K-94-2
EFFECTIVE DATE 7/7/94
6509.11k,33 Ex 01-02
Page 1 of 2
33 - EXHIBIT 01
FS-6500-89 (6/92)
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USDA - Forest Service
| 1. Date of Issue
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BILL FOR COLLECTION
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April 1, 19-- (1)
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|\ Please send money order, bank draft, or check
/| 2. Issuing Office Address
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|\\ payable to: USDA-FOREST SERVICE at the following address: //|
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NORTHERN REGION; FILE #51653
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Dillon, MT
(2)
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P.O. Box 60000, San Francisco, CA 94160-1653 (3) \|
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FOR INFORMATION Please call |
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XYZ Lumber Co.
- or write
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P. O. Box 96
(4)
to the issuing office address.
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Anywhere, MT 59999
DO NOT send correspondence or |
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change of address with your payment. |
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---> FOR PROPER CREDIT be sure to include a copy of this Bill with your payment <--|
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Fold
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| 3. Date or Period
| 4. Description
| 5. Amount
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3/1 to 3/31/-| Payment for Timber cut per Statement of Account #8
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$10,000.00
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(5)
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(6)
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(7)
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| 6. Bill Number | 7. Unit Number | 8. Subunit/ Contract Number| 9. Payment Due Date | 10. Amount Due
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| 572 (8) |
TM-01 (9) |
124711 (10)
| May 1, 19-- (11)
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$10,000.00
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|\ Note: Payments not received by the due date are subject to a LATE PAYMENT CHARGE at the rate published /|
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by the Department of the Treasury unless a different rate is prescribed by contract or agreement.
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Postmarks are not honored. ADMINISTRATIVE CHARGES may also be assessed. An additional 6% \\|
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PENALTY will be charged for payments over 90 days past due. (Authority: Debt Collection Act of 1982.)
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| 11. Remarks
| 12. Forest Service Accounting Data
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| TRANS. | MANAGEMENT | OBJECT | AMOUNT
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| CODE | CODE/FY
| CLASS |
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A
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870100
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| $10,000.0
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| (12) |
(13)
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(13) |
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TOTAL ---------> | $10,000.00
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R1 SUPPLEMENT 6509.11K-94-2
EFFECTIVE DATE 7/7/94
6509.11k,33 Ex 01-02
Page 1 of 2
33 - EXHIBIT 02
REQUEST TO BILL
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| Bill Number
| Date
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PAYER
| 00097 (2)
| May 12, 19-- (3)
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|Name & Address
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CREDIT
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| Appropriation
| Work Plan Code |
| BUREAU OF LAND MANAGEMENT |
564105 (4)
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TM-02 (5) |
| PO BOX 36800
(1)
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| BILLINGS, MT 59107
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PERIOD COVERED
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| From
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4/14/-- (6)
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4/18/-(7) |
| Object Class |
Description
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Amount
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| T/C 2
| To bill for cost incurred by Beaverhead Forest
| 555640 100.00 |
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| in rehabilitating fire area.
| 555642 300.00 |
| BO 0250
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| 444240 500.00 |
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| 333520 1000.00 |
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(8)
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(9)
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(10)
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BILL THROUGH OPAC
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14110008
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| INCLUDE THE FOLLOWING INFORMATION
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| IN THE OPAC DOCUMENT DESCRIPTION
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| BLOCK:
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E950M4 0192 SF-182 IN-05-1829
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| CONTACT PERSON USDA FS-KEITH THURLKILL|
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406-329-3602
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| CONTACT PERSON BLM - RITE STOCKDALE
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406-255-2780
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| AUTHORITY
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| Economy Act
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(11)
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AMOUNT TO BE BILLED | (12)
1900.00 |
|I certify that the above charges are correct and proper.
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|Agency
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USDA-Forest Service (13)
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Beaverhead NF (14) | May 12, 19-- (15) |
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|Signature (Administrative or Liaison Officer) | Phone (Area code & number)
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| Joe Ranger
(16)
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(17) |
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AD-673 (Rev.7/89) USDA