Form 3440-1 Application and License to Mine Coal (Free Use)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND M A N A G E M E N T

Form 3440-1
(-XQH)

FORM APPROVED

OMB NO. 1004-0073

Expires: August 31, 2016

APPLICATION AND LICENSE TO MINE COAL
(FREE USE)

Office and Serial Number

No License may be awarded unless a completed Application form has been filed with the Bureau
of Land Management (BLM). Mineral Leasing Act, as amended (30 U.S.C. 181 et seq.)

SUBMIT 4 COPIES

APPLICATION
of

We,

of

of

of
hereby apply for a license to mine and remove coal from the following-described land:

acres, and in support of this application each states that he is a citizen of the United States and that the purpose for which the
containing
coal mined hereunder is to be used is:

for which approximately total of
Is the filing fee attached?

Yes

tons is required annually.
No

(If "no,"

explain)

LICENSE

In consideration of the granting of the license applied for, the applicant(s) hereby
agree(s) to the following express terms and conditions to wit:

Sec. 1. That only so much of the land as may be necessary to conduct mining
operations hereunder will be used or occupied by said licensee(s). The right is
reserved by the Bureau of Land Management (BLM) to dispose of any portion of said
land not already disposed of with reservation to the coal deposits, under any act
authorizing such disposition, such licensee(s) to observe in mining operations
hereunder all provisions of the laws under which any part of the land has been or may
hereafter be disposed of with reservation of the coal deposits therein and the right to
mine and remove the same.
Sec. 2a. That all mining and removal of coal hereunder will be conducted in
accordance with approved methods and practices, as provided in the operating
regulations (43 CFR 3480 and 30 CFR Chapter VII); that due provisions will be
made for prevention of fires in the mine or mines opened hereunder and for the safety
of miners or other workmen engaged therein, and reasonable diligence, skill, and care
will be exercised in all mining operations hereunder.

license lands and improvements thereon whether or not owned by the
United States.
Cultural Resources. If any items of historical, cultural, or archeological value
c.
are discovered during performance of this license, licensee will immediately notify
the BLM and not disturb such items or features until the BLM issues instructions. If
licensee is ordered to take measures to protect any items or features of historical,
cultural, or archeological value discovered during performance on this license, cost
of the measures will be borne by licenser and such items and features will remain
under jurisdiction of the United States.

Sec. 3. That the license is granted for a period of 2 years from the date hereof,
which may be extended upon application for such an extension and satisfactory
showing as to the mining of coal from the land, giving the amount of coal mined, the
disposition made thereof, and the condition of the mine.

Sec. 4. That the right is reserved to cancel this license at any time, after a 30-day
notice of such purpose, for failure to mine and use the coal deposits in accordance
with the conditions and provisions of the act under which this license is issued, for
b. Protection of surface, natural resources, and improvements. The licensee(s) committing waste or other unnecessary damage to the land or the deposits therein,
agree(s) to take such reasonable steps as may be needed to prevent operations on the for abandonment or nonuse, or for other violation of the terms of this license; that in
leased lands from unnecessarily; (1) causing or contributing to soil erosion or case this license is canceled prior to its expiration, or expires by limitation, all
damaging crops, including forage, and timber growth thereon or on Federal or non- mining machinery, tools, and appliances placed thereon by said licensee(s), except
Federal lands in the vicinity; (2) polluting air and water; (3) damaging improvements underground supports or structures necessary for the preservation of the mine, will
owned by the United States or other parties; or (4) destroying, damaging or be removed within 60 days from the date of expiration of notice of such cancellation;
removing fossils, historic or prehistoric ruins, or artifacts; and upon any partial or otherwise said machinery, tools, and appliances will become the property of the
total relinquishment or the cancellation or expiration of this license, or at any other United States.
time prior thereto when required and to the extent deemed necessary by the lessor to
fill any pits, ditches and other excavations, remove or cover all debris, and so far as Sec. 5. That the right is reserved to the Bureau of Land Management to permit,
reasonably possible, restore the surface of the licensed land and access roads to their upon such terms as may determine to be just, for joint or several uses, such
former conditions, including the removal of structures as and if required. The lessor easements or rights-of-way, including easements in tunnels upon, through, or in said
may prescribe the steps to be taken and restoration to be made with respect to the lands, as may be necessary or appropriate to the working of the same or of other
(Continued on page 2)

lands containing coal or other deposits described in said act, and the treatment and
shipment of the products thereof by or under authority of the United States, its lessees
or permittees, and for other public purposes; also the right to dispose of any other
mineral deposits in the lands and the right to lease, sell, or otherwise dispose of the
surface of the lands existing under law or laws hereafter enacted insofar as said
surface is not necessary for the use of the licensee(s) in his operations hereunder.

Sec. 6. Equal opportunity clause. The licensee will comply with all provisions of

Executive Order No. 11246 of September 24, 1965, and the rules, regulations, and
relevant orders of the Secretary of Labor. Neither licensee nor licensee's
subcontractor should maintain segregated facilities.

Sec. 7.

That the licensee(s) must submit operation and production reports in
accordance with the provisions of the operating regulations (43 CFR 3480 and 43
CFR 3440).

Sec. 8. That operations under this license will be conducted in such a way as not to
interfere with the administration and use of the land to a greater extent than may be
determined by the Bureau of Land Management to be necessary for the most
beneficial use of the land in case any of land described herein is embraced in a forest,
reclamation, power or other withdrawal, or is segregated for any particular purpose.

Sec. 9. Special Stipulations

WE CERTIFY That our purpose in obtaining this permit are consistent with purposes set forth in 43 CFR 3440.

(Date)

(Date)

(Applicant's Signature)

(Applicant's Signature)

(Date)

(Applicant's Signature)

(Date)

(Applicant's Signature)

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any department or agency of the United
States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

LICENSE APPROVED
Mineral Leasing Act (30 U.S.C. 181), or
Acquired Land Leasing Act (30 U.S.C. 351), and 43
A license for the lands, described above, is hereby issued under the
CFR 3440, and is subject to all regulations now or hereafter in force when not inconsistent with any expressed and specific provisions herein, and to the terms and conditions
forth in this license.

(Effective date of this license)

(Continued on page 3)

(Bureau of Land Management)

(Form 3440-1, page 2)

NOTICES
The Privacy Act and 43 CFR 2.48(d) require that you be furnished the following information in connection

with information required by this form.

AUTHORITY: 30 U.S.C. 208 permits collection of the information requested by this form.

PRINCIPAL PURPOSE: The BLM will use the information you provide to process your application, to record

adjudicative actions taken on your application and any subsequent license, to document administrative

actions taken, and to determine whether or not you are complying with the provisions of your license.

ROUTINE USES: The BLM will only disclose this information in accordance with the provisions at

43 C FR 2. 56(b) and (c).

EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain

a benefit. Failure to submit all the requested information or to complete this form may result in delay or preclude the

BLM's acceptance of your application for a coal lease.

The Paperwork Reduction Act requires us to inform you that:

BLM collects this information to determine whether or not you are qualified to hold a license to mine coal.

Submission of the requested information is necessary to obtain or retain a benefit.

You do not have to respond to this or any other Federal agency-sponsored information collection unless it displays a

currently valid OMB control number.

BXUGHQ+RXUV6WDWHPHQW: Public reporting burden for this form is estimated to average 21 hours per

response, including the time for reviewing instructions, gathering and maintaining data, and completing and

reviewing the form. You may submit comments regarding the burden estimate or any other aspect of this form to:

U.S. Department of the Interior, Bureau of Land Management (1004-0073), Bureau Information Collection Clearance
Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

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(Form 3440-1, page 3)