5-5523 Assignment of Grazing Permit

Form 5-5523		OMB No. 1076-0157 Expires: ##/##/####
Range Unit: Contract No.:	UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF INDIAN AFFAIRS
	ASSIGNMENT OF GRAZING PERMIT

Permittee ____________________________		Range Unit ___________________________
Contract No. __________________________		Reservation __________________________
Permit period ___/___/______ to ___/___/______		Agency _____________________________
Date Issued ___/___/______		Annual Grazing Rental $ ________________

ASSIGNMENT

I, the Permittee of record of the above‑described grazing permit, including all modifications thereto, hereby transfer, set over, and assign all my right, title and interest in and to the subject grazing permit, subject to the approval of the Secretary of the Interior or his duly authorized representative, to Assignee ___________________________________, effective the ____ day of __________, _______.

ACCEPTANCE

I, 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 accept said assignment and agree to fulfill all the obligations, conditions, stipulations and requirements of the subject permit, and the regulations at 25 CFR 166 and as may hereafter be amended, and hereby agree to furnish proper bond guaranteeing faithful compliance with said permit thus assigned (Strike out bond reference if not applicable), firmly binding myself, my heirs, executors, administrators, successors or assignees to full compliance therewith.

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 assigned permit:

CATTLE BRANDS (R L) EAR MARK (R L) HORSE BRANDS (R L) SHEEP EAR MARK (R L)

WOOL MARK

Assignment Administration Fee: $__________
Approved:		Accepted:
__________________________ ___/___/___		__________________________ ___/___/___
Superintendent		Permittee

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.