FS-2300-26a Fee Envelope

02 Feb 2016

SIDE
A

FS-2300-26a (5-2013)
VISUAL SAMPLE ONLY

123456789

No Days
Paid:
Date Out:
Date In:

PROOF OF PAYMENT
of Recreation Fee

Detach and place stub following posted instructions

USDA Forest Service

No. Days
Paid:
Date Out:
Date In:

of Recreation Fee

PROOF OF
PAYMENT

perforate hangtag
and stub
fold here to form
flap and place
adhesive on
underside for
moistening
and sealing

Recreation Fee Site

HANGTAG

Detach from envelope and hang from
rearview mirror this side out.

Personal
removeable
permit stub

STUB

123456789

Placeholder number, use your own
sequential permit numbering system

Die cut hangtag hole and slit
Personal
removeable
permit
hangtag

flat: 8”W X 9.5H
assembled: 6 1/8”W X 3.58”H

Recreation Fee Site

Detach hangtag and stub

PAYMENT ENVELOPE

Fee
Envelope

See posted fee and information for this site.
To validate, complete the following:
2. # of Day(s) Paid

5. Vehicle Make & License # 6. State

7. Home Zip Code

3. Date In

8. # In Party

4. Date Out

123456789

1. Amount Enclosed

9. Other Charges

Reference
FSM 2300
10. Interagency Senior or Access, or Golden Passport #

OMB #
0596-0106

11. Campsite # (if camping)

fold to INSIDE and glue

fold to INSIDE and glue

U.S. currency and checks drawn on U.S. banks accepted. Please do not
fold bills or checks. Make checks payable to USDA Forest Service.
Deposit payment envelope into box provided.
FS-2300-26a (5-2013)

Single Campsite
Group Campsite

Campsite # __________
Campsite # __________ # in group

Fold-in
to cover
non printed
side to
form bottom
pocked of
envelope

For campsites please complete information below:
____________________________________________
Fold-this flap
up to form
pocket and
glue to side
tabs

Cheri Ziebart,
Business Graphics
Integrated Resources Enterprise Team
USDA Forest Service
206-780-0471 or cziebart@fs.fed.us

SITE NAME

Fold both
side tabs to
inside, fold
bottom flap
up and glue
to form
envelope
pocket.

die cut 3 window see-through holes
(for viewing inside contents

Kathy Mitchell
Integrated Resources Enterprise Team
541-308-0346 or kkmitchell@fs.fed.us

Placeholder,
use your
own
sequential
permit
numbering
system

02 Feb 2016

flat: 8”W X 9.5”H
assembled: 6 1/8”W X 3”H

FS-2300-26a (5-2013)
VISUAL SAMPLE ONLY

SIDE
B

Inside of fee envelope and back side of hangtag permit

Thank you, your fees
are making a difference!
According to the Paperwork Reduction Act of 1995, an agency may
not conduct or sponsor, and a person is not required to respond to
a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is
xxxxxxxx. The time required to complete this information is estimated
to average 3 minutes, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
In accordance with Federal civil rights law and U.S. Department of
griculture (USDA) civil rights regulations and policies, the USDA, its
Agencies, offices, and employees, and institutions participating in
or administering USDA programs are prohibited from discriminating
based on race, color, national origin, religion, sex, gender identity
(including gender expression), sexual orientation, disability, age, marital
status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights
activity, in any program or activity conducted or funded by USDA (not all
bases apply to all programs). Remedies and complaint filing deadlines
vary by program or incident.

Kathy Mitchell
Integrated Resources Enterprise Team
541-308-0346 or kkmitchell@fs.fed.us

Cheri Ziebart,
Business Graphics
Integrated Resources Enterprise Team
USDA Forest Service
206-780-0471 or cziebart@fs.fed.us

Persons with disabilities who require alternative means of ommunication
for program information (e.g., Braille, large print, audiotape, American
Sign Language, etc.) should contact the responsible Agency or USDA’s
TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
through the Federal Relay Service at (800) 877-8339. Additionally,
program information may be made available in languages other than
English.
To file a program discrimination complaint, complete the USDA Program
Discrimination Complaint Form, AD-3027, found online at http://www.
ascr.usda.gov/complaint_filing_cust.html and at any USDA office or
write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint
form, call (866) 632-9992. Submit your completed form or letter to
USDA by: (1) mail: U.S. Department of Agriculture, Office of the
Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW,
Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email:
program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.

NOTICE:

You are responsible for your own safety. Recreation use has inherent
risks and you may encounter a variety of unexpected and/or dangerous conditions which may lead to serious injury or death. It is your
responsibility to be informed and take precautions.
www.fs.usda.gov

Adhesive strip to moisten for closure