Form 1822-4
(September 2019)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
CASH BOND
(Assured Payment)
Contract Number
Date Contract Approved
Kn o w Al l Me n b y Th e s e Pr e s e n T s , That I We
of
, State of
doing business as an individual partnership
corporation organized and existing under the laws of the
State of
as Principal, is held and rmly bound unto the United States of America
in the penal sum of
dollars ( ),
lawful money of the United States, for the payment of which, well and truly to be made, I bind myself, my heirs,
executors, administrators, successors and assigns, jointly and severally, as a further guarantee of which a cash
deposit or assured payment has been made with the Bureau of Land Management at
in the form of a in the amount of
.
A
shall not be negotiated unless the principal, his successors or assigns, fails to comply
with all of the provisions of the above-cited contract. (As used herein, the term “contract” includes all agreements
between the Bureau of Land Management and any individual, partnership or corporation for use of the public lands or
their resources.)
T
h A T , The said Principal does hereby constitute
and appoint the Secretary of the Interior as his attorney,
to transfer and apply the said deposit, as security for
the faithful performance of any and all of the conditions or
stipulations as set out in the above-noted contract made un-
der the Act of August, 28, 1937, (50 Stat. 874) or the Act
of July 31, 1947 (61 Stat. 681), as amended, 30 U.S.C. Secs.
601-604 and the regulations thereunder set forth in 43 CFR,
Part 5400, upon conditions therein expressed, and it
is agreed that, in case of any default in the performance
of any condition or stipulation of such contract, the said
attorney shall have full power to assign, appropriate,
transfer, and apply said deposit or any part thereof,
without notice, and to apply the proceeds of such
collection in whole or in part to the satisfaction of any-
damages or deciencies, arising by reason of such
default, as said attorney may deem best.
The said Principal hereby raties and conrms
whatever his said attorney shall do by virtue of these
presents.
If the said Principal, his successors or assigns
shall fully comply with all the provisions of the above-
described contract and shall make all payments due
under said contract as therein provided, then and in
that event the above obligation shall be null and void
and the deposit shall be released and returned to the
Principal. Otherwise, said obligation shall remain in
full force and effect.
(Continued on page 2)
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Signed, sealed, and delivered this day of , 20 .
IF INDIVIDUAL OR PARTNERSHIP, SIGN HERE:
(Printed Name)
By
(Signature)
(Address)
(Signature)
(Address)
(Signature)
(Address)
(Signature)
(Address)
IN THE PRESENCE OF TWO WITNESSES:
(Signature of Witness)
(Address)
(Signature of Witness)
(Address)
IF CORPORATION, SIGN HERE:
(Name of Corporation)
By
(Signature)
(Title)
T
HE
U
NITED
S
TATES OF
A
MERICA
Signed and Approved:
(Date)
By
(Signature)
(Title)
CORPORATION CERTIFICATE
If Purchaser is a corporation, the following certicate shall be executed by the Secretary or Assistant Secretary of the
Corporation.
I, , certify that I am the Secretary of
the corporation named as Purchaser herein; that , who signed this
contract, was then of said corporation; that said contract was duly signed for and in
behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers.
(Corporate Seal)
Title 18 U.S.C. Section 1001, makes 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.
(Form 1822-4, page 2)
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