5-5523 Grazing Permit

Form 5-5523 UNITED STATES OMB No. 1076-0157

DEPARTMENT OF THE INTERIOR Expires: 02/28/2007

BUREAU OF INDIAN AFFAIRS

Execution fee: $______________

ASSIGNMENT OF GRAZING PERMIT

Range Unit No. _____________________________________ __________________________________________________Agency

Contract No. _______________________________________ __________________________________________________ Reservation

Permittee. ______________________________________ Date of Permit ____________________________________________

Permit Period ____________________________________ Annual Grazing Fees $ _____________________________________

For and in consideration of one dollar ($1.00) the receipt of which is hereby acknowledged, the said Permittee of the above‑described grazing permit, including all modifications thereto, hereby bargains, sells, transfers, sets over, and assigns all his right, title and interest in and to said grazing permit, subject to the approval of the Secretary of the Interior or his duly authorized representatives, to ______________________________________, effective as of ______________________________________

(Month / Year)

IN WITNESS WHEREOF the said Permittee of the foregoing grazing permit has hereunto set his hand and seal this ________ day of _____________________________

(Month / Year)

WITNESSES:

_________________________________________________ ___________________________________________________ [SEAL]

Assignor (Permittee)

_________________________________________________

ACCEPTANCE BY ASSIGNEE

The Assignee in the above and foregoing assignment, made subject to the approval of the Secretary of the Interior or his duly authorized representatives hereby accepts such assignment and agrees to fulfill all the obligations, conditions, stipulations and requirements of said permit, and the regulations (25 CFR 166), and as may hereafter be amended, and hereby agrees to furnish proper bond guaranteeing faithful compliance with said permit thus assigned, firmly binding himself, his heirs, executors, administrators, successors or assignees to full compliance therewith. (Delete bond reference if not applicable)

Unless authorized by the officers issuing and approving this permit in writing only livestock bearing the brands and marks herein shown shall be grazed under authority of this permit:

CATTLE BRANDED EAR MARK HORSE BRANDS SHEEP BRANDED EAR MARK

R L R L R L Wool Brand R L

WITNESSES:

________________________________________________ _______________________________________________[SEAL]

(Assignee)

________________________________________________

APPROVED: __________________________________________

(Superintendent)

Paperwork Reduction Act Statement: This information is collected to manage agriculture and grazing leases. The information is

Form 5-5523 OMB No. 1076-0157

Expires: 02/28/2007

supplied by a respondent to obtain or retain a benefit, that is, a lease. It is estimated that responding to the request will take an average of 20 minutes to complete. This includes the amount of time it takes to understand directions, gather the information and fill out the form. If you wish to make comments on the form, please send them to the Information Collection Clearance Officer, Bureau of Indian Affairs, 625 Herndon Parkway, Herndon, VA 20170. Note: comments, names and addresses of commentors are available for public review during regular business hours. If you wish us to withhold this information, you must state this prominently at the beginning of your comment. We will honor your request to the extent allowable by law. In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a number and expiration date. The number and expiration date are at the top right corner of the form. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless there is a valid OMB clearance number.