5-5523 Assignment of Grazing Permit

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

DEPARTMENT OF THE INTERIOR Expires: __________

BUREAU OF INDIAN AFFAIRS

Administrative 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 representative, to ______________________________, effective as of ________________________.

(Month / Year)

____________________________________________________________________

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 representative 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 BRAND EAR MARK HORSE BRAND SHEEP MARK EAR MARK

R L R L R L R L R L

________________________________________________________

(Assignee)

APPROVED: __________________________________________

(Superintendent)

Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act.  It is used to establish the respective rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or retain a benefit.  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 an expiration date.  The number and expiration date are at the top right corner of the form.  An agency may not sponsor or conduct, and a person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number.  The public reporting burden is estimated to average 20 minutes per respondent.  This includes the time needed to understand the requirements, gather the information, complete the form, and submit it to the Department.  Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.