R4 SUPPLEMENT 2700-92-3
EFFECTIVE 10/30/92
2715.23a_Ex.01_04
Page 1 of 4
FSM 2700 - SPECIAL USES MANAGEMENT
R4 SUPPLEMENT 2700-92-3
EFFECTIVE 10/30/92
2715.23a - Exhibit 01
Following is a sample Bill for Collection to be included with the letter to the holder when
payment is 1-5 days overdue. It shows the application of the first administrative charge.
FS-6500-89
(5/92)
USDA – Forest Service
1. Date of Issue
January 3, 1992
BILL FOR COLLECTION
Please send money order, bank draft, or check payable to:
USDA – FOREST SERVICE at the following address:
COLLECTION OFFICER, ASHLEY NATIONAL FOREST
355 NORTH VERNAL AVENUE
VERNAL, UT 84078
(A pre-addressed envelope is enclosed for your convenience)
_
_
|
|
Mr. Joe Permittee
1234 Nowhere Street
Anywhere, UT 8000
|_
_|
2. Issuing Office Address
324 25th Street
Vernal, UT 84078
FOR INFORMATION Please call or
write to the issuing office address.
DO NOT send correspondence or
change of address with your payment.
 FOR PROPER CREDIT be sure to include a copy of this Bill with your payment 
-------------------------------------------------------------------------------------Fold--------------------------------------------------------------------------------3. Date or Period
4. Description
5. Amount
1/1-12/31/1992
Racetrack Permit #5555
$100.00
Administrative Charge
6. Bill Number
7. Unit Number
TP01
35.00
8. Subunit/Contract
Number
9. Payment Due
Date
10. Amount Due
January 31, 1992
$135.00
Note: Payments not received by the due date are subject to a LATE PAYMENT CHARGE at the rate published by the
Department of the Treasury unless a different rate is prescribed by contract or agreement. Postmarks are not honored.
ADMINISTRATIVE CHARGES may also be assessed. An additional 6% PENALTY will be charged for payments over 90 days
past due. (Authority: Debt Collection Act of 1982.)
11. Remarks
12. Forest Service Accounting Data
TRANS.
MANAGEME
OBJECT
AMOUNT
CODE
NT CODE/FY
CLASS
A
8904
01
$100.00
A
8990
15
35.00
Total -----------
$135.00
R4 SUPPLEMENT 2700-92-3
EFFECTIVE 10/30/92
2715.23a_Ex.01_04
Page 2 of 4
2715.23a - Exhibit 02
Following is a sample Bill for Collection to be included with the letter to the holder when
payment is 30 days overdue. It shows the application of the second administrative charge and the
first interest charge.
FS-6500-89 (5/92)
1. Date of Issue
USDA – Forest Service
February 1, 1992
BILL FOR COLLECTION
Please send money order, bank draft, or check payable to:
USDA – FOREST SERVICE at the following address:
COLLECTION OFFICER, ASHLEY NATIONAL FOREST
355 NORTH VERNAL AVENUE
VERNAL, UT 84078
(A pre-addressed envelope is enclosed for your convenience)
_
_
|
|
Mr. Joe Permittee
1234 Nowhere Street
Anywhere, UT 8000
|_
_|
2. Issuing Office Address
324 25th Street
Vernal, UT 84078
FOR INFORMATION Please call or
write to the issuing office address.
DO NOT send correspondence or
change of address with your payment.
 FOR PROPER CREDIT be sure to include a copy of this Bill with your payment 
-------------------------------------------------------------------------------------Fold--------------------------------------------------------------------------------3. Date or Period
4. Description
5. Amount
1/1-12/31/1992
Racetrack Permit #5555
$100.00
Administrative Charge
70.00
Interest, 6-7/8%, 1/1-1/31/92
6. Bill Number
7. Unit Number
TP01
.56
8. Subunit/Contract
Number
9. Payment Due
Date
March 1, 1992
10. Amount Due
$170.56
Note: Payments not received by the due date are subject to a LATE PAYMENT CHARGE at the rate published by the
Department of the Treasury unless a different rate is prescribed by contract or agreement. Postmarks are not honored.
ADMINISTRATIVE CHARGES may also be assessed. An additional 6% PENALTY will be charged for payments over 90 days
past due. (Authority: Debt Collection Act of 1982.)
11. Remarks
12. Forest Service Accounting Data
TRANS.
MANAGEME
OBJECT
AMOUNT
CODE
NT CODE/FY
CLASS
A
8904
01
$100.00
A
8990
15
70.00
A
8990
13
.56
Total -----------
$170.56
R4 SUPPLEMENT 2700-92-3
EFFECTIVE 10/30/92
2715.23a_Ex.01_04
Page 3 of 4
2715.23a - Exhibit 03
Following is a sample Bill for Collection to be included with the letter to the holder when
payment is 60 days overdue. It shows the application of the third administrative charge and the
second interest charge.
FS-6500-89 (5/92)
1. Date of Issue
USDA – Forest Service
March 2, 1992
BILL FOR COLLECTION
Please send money order, bank draft, or check payable to:
USDA – FOREST SERVICE at the following address:
COLLECTION OFFICER, ASHLEY NATIONAL FOREST
355 NORTH VERNAL AVENUE
VERNAL, UT 84078
(A pre-addressed envelope is enclosed for your convenience)
_
_
|
|
Mr. Joe Permittee
1234 Nowhere Street
Anywhere, UT 8000
|_
_|
2. Issuing Office Address
324 25th Street
Vernal, UT 84078
FOR INFORMATION Please call or
write to the issuing office address.
DO NOT send correspondence or
change of address with your payment.
 FOR PROPER CREDIT be sure to include a copy of this Bill with your payment 
-------------------------------------------------------------------------------------Fold--------------------------------------------------------------------------------3. Date or Period
4. Description
5. Amount
1/1-12/31/1992
Racetrack Permit #5555
$100.00
Administrative Charge
105.00
Interest, 6-7/8%, 1/1-2/28/92
6. Bill Number
7. Unit Number
TP01
1.13
8. Subunit/Contract
Number
9. Payment Due
Date
April 1, 1992
10. Amount Due
$206.13
Note: Payments not received by the due date are subject to a LATE PAYMENT CHARGE at the rate published by the
Department of the Treasury unless a different rate is prescribed by contract or agreement. Postmarks are not honored.
ADMINISTRATIVE CHARGES may also be assessed. An additional 6% PENALTY will be charged for payments over 90 days
past due. (Authority: Debt Collection Act of 1982.)
11. Remarks
12. Forest Service Accounting Data
TRANS.
MANAGEME
OBJECT
AMOUNT
CODE
NT CODE/FY
CLASS
A
8904
01
$100.00
A
8990
15
105.00
A
8990
13
1.13
Total -----------
$206.13
R4 SUPPLEMENT 2700-92-3
EFFECTIVE 10/30/92
2715.23a_Ex.01_04
Page 4 of 4
2715.23a - Exhibit 04
Following is a sample Bill for Collection to be included with the letter to the holder when
payment is 90 days overdue. It shows the application of the forth administrative charge, the third
interest charge, and the first penalty charge.
FS-6500-89 (5/92)
1. Date of Issue
USDA – Forest Service
April 2, 1992
BILL FOR COLLECTION
Please send money order, bank draft, or check payable to:
USDA – FOREST SERVICE at the following address:
COLLECTION OFFICER, ASHLEY NATIONAL FOREST
355 NORTH VERNAL AVENUE
VERNAL, UT 84078
(A pre-addressed envelope is enclosed for your convenience)
_
_
|
|
Mr. Joe Permittee
1234 Nowhere Street
Anywhere, UT 8000
|_
_|
2. Issuing Office Address
324 25th Street
Vernal, UT 84078
FOR INFORMATION Please call or
write to the issuing office address.
DO NOT send correspondence or
change of address with your payment.
 FOR PROPER CREDIT be sure to include a copy of this Bill with your payment 
-------------------------------------------------------------------------------------Fold--------------------------------------------------------------------------------3. Date or Period
4. Description
5. Amount
1/1-12/31/1992
6. Bill Number
Racetrack Permit #5555
$100.00
Administrative Charge
140.00
Interest, 6-7/8%, 1/1-3/31/92
1.69
Penalty, 6% 1/1-4/1/92
1.48
7. Unit Number
TP01
8. Subunit/Contract
Number
9. Payment Due
Date
May 1, 1992
10. Amount Due
$243.17
Note: Payments not received by the due date are subject to a LATE PAYMENT CHARGE at the rate published by the
Department of the Treasury unless a different rate is prescribed by contract or agreement. Postmarks are not honored.
ADMINISTRATIVE CHARGES may also be assessed. An additional 6% PENALTY will be charged for payments over 90 days
past due. (Authority: Debt Collection Act of 1982.)
11. Remarks
12. Forest Service Accounting Data
TRANS.
MANAGEME
OBJECT
AMOUNT
CODE
NT CODE/FY
CLASS
A
8904
01
$100.00
A
8990
15
105.00
A
8990
13
1.13
A
8990
09
1.48
Total -----------
$243.17