Form 5-5515 Grazing Permit

Form 5-5515

	UNITED STATES	OMB # 1076-0157
Contract No.:	DEPARTMENT OF THE INTERIOR	OMB # Expires _________
Range Unit:	BUREAU OF INDIAN AFFAIRS
Agency:	GRAZING PERMIT
Reservation:
Tribe:

By authority of law and under regulations (25 CFR 166) prescribed by the Secretary of the Interior, ,

(Name of permittee)

, is hereby granted permission to graze livestock on the Trust Indian

(Post office address)

and Government-owned lands within Range Unit of the Indian Reservation,

as described on the attached land schedule, for a period beginning / / , and terminating not later than / / .

(Date) (Date)

CLASS OF LIVESTOCK	NUMBER OF HEAD	ANIMAL UNIT MONTHS	GRAZING SEASON
			From --	To --

The Grazing Rental for this permit is $___________________ plus an Administrative fee of $___________________, for a total payment of $ __________________ due annually on _____________. The Grazing Rental is subject to annual review and adjustment under 25 CFR 166.408. The administrative fee is payable annually under 25 CFR 166.500 et seq.

Animal Identification, Only livestock bearing the brands and marks herein shown shall be grazed under authority of this permit unless authorized by the Superintendent of the Agency in writing with a pasturing authorization:

CATTLE BRANDS EAR MARK HORSE BRANDS SHEEP EAR MARK

L R L R

WOOL MARK

Issued at the above Agency this_____ day of _______________________________by ______________________________________________

Month/Year (Superintendent)

Attached to and made part of this permit are the Land Schedule, Range Control Stipulations and Conservation Plan.

I accept this permit and attachments. ______________________________________________

(Permittee)

(SEE‑PAGE 2 FOR ADDITIONAL TERMS AND CONDITIONS)

Page 2

GRAZING PERMIT

ADDITIONAL TERMS AND CONDITIONS

Payment of Rental - In consideration of the privileges granted by this permit the permittee agrees to pay the grazing rental and all other applicable taxes and fees due annually according to 25 CFR 166.409-418, 166.500-504, and the provisions of this permit.

Bond and Insurance Requirement - An acceptable bond guaranteeing full performance of this permit may be required pursuant to 25 CFR 166.600-608.

Rental Adjustment - Grazing rental may be adjusted annually pursuant to 25 CFR 166.408.

Termination and Modification - It is understood and agreed that this permit may be modified or terminated in whole or in part pursuant to 25 CFR 166.227-231

Trust Lands Not Covered By Permit- It is understood and agreed by the permittee that he is authorized to graze livestock on the lands covered by the permit as listed on the attached land schedule and is responsible to prevent his livestock from grazing on lands not covered by this permit. Failure to comply with this requirement may be cause for termination of the permit.

Assignment or Subletting - This permit will not be assigned or sublet without written consent of the Agency Superintendent pursuant to 25 CFR 166.229-231.

Interpretation of Permit Provisions - The Superintendent will make decisions relative to the interpretation of the terms of this permit and the Range Control Stipulations which are attached hereto. The terms of this permit cannot be varied in any detail as herein provided without the written approval of the parties thereto and the surety.

Right-of-Way - It is understood and agreed that authority is reserved to the Superintendent to grant access to and across any of the lands covered by this permit as deemed in the interest of the Indian landowner, including the privilege of prospecting for oil, gas, and other minerals.

Entry on Premises - BIA approving official or his/her representative may enter upon the premises covered by this permit at such reasonable times as may be desired for inspection or enforcement.

Indemnity -The permittee agrees to indemnify the United States and the Indian landowners against all liabilities or costs relating to the use, handling, treatment, removal, storage, transportation, or disposal of hazardous materials, or the release or discharge of any hazardous materials from the permitted premises that occur during the contract term, regardless of fault.

Filing of Permits - The Agency office contains public records of the United States pertaining to Trust Indian allotments. A copy of this permit will be filed in the Agency office and shall be available for public inspection during normal business hours. A copy of this permit shall be recorded in the Land Titles and Records office which has jurisdiction. The permittee may file or record a copy of this permit, at his own expense, in the proper county office.

Applicable Federal, State and Tribal Laws - The permittee must comply with all applicable Federal and State laws, rules, regulations, and other legal requirements. The permittee must also comply with all applicable Tribal laws, ordinances, resolutions and policies.

Distribution of Trespass Proceeds - Any funds collected by the BIA for trespass penalties or damages to trust lands will be distributed pursuant to 25 CFR 166.818:

Permittee Obligation - While the lands covered by the permit are in trust or restricted status, all of the permittee's obligations under the permit and the obligation of his sureties are to the United States as well as to the owner of the land. The permittee is prohibited from creating a nuisance, any illegal activity, and negligent use or waste of resources.

Authorized Uses -The permit authorizes the grazing of livestock only and the permittee shall not utilize the permitted area for hay cutting, hunting, post or timber cutting, or any other use without written authorization from the responsible Indian or Federal authority.

SPECIAL PERMIT REQUIREMENTS AND PROVISIONS

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.