Form 2001-001
UNITED STATES DEPARTMENT
(June 2014)
OF THE INTERIOR BUREAU OF
LAND MANAGEMENT
BIDDER REGISTRATION FORM
Competitive Land Sale
By completing this form, I certify that the undersigned, or the principal party whom the undersigned is acting on behalf of, is in compliance
with the applicable sale regulations and authorities governing a bid and subsequent issuance of a patent. I certify that any bid submitted by
the undersigned, either on their own behalf or on behalf of the principal party named below, is a good faith statement of intention by the
undersigned or the principal party to acquire a patent on the offered lands bid upon. Further, I acknowledge that if a bid is declared the high
bid
, it will constitute a legally binding commitment by the Bureau of Land Management (BLM) to execute and issue a patent on the parcel
for which the high bid has been received, upon payment to the BLM of the full bid amount.
In addition, if a bid is declared the high bid on a parcel offered for sale, the undersigned or the principal party will pay to the BLM a 20%
deposit of the high bid amount for that sale parcel by 3:00 p.m. on the day of the auction. The undersigned, and the principal party if other
than the undersigned, acknowledge that these monies are due to the BLM as a result of the undersigned having been determined to have
made the high bid on the parcel offered for sale
. Further, the undersigned and the principal party understand that if payment for the 20%
deposit is not received by the specified time, the BLM may cancel the sale of that parcel and, further, if the final payment for the sale parcel
is not received by the due date, the BLM may retain the bid deposit and cancel the sale of that parcel.
It is a crime under 18 U.S.C. 1001 and 43 U.S.C. 1212 for any person to knowingly and willfully make any false, fictitious, or fraudulent
statements or representations as to any matter within the jurisdiction of the government. Any such offense may result in a fine or
imprisonment for not more than 5 years, or both.
A separate registration is required for each company or individual you are representing.
Please fill in the company/individual name and address as it would appear on the patent. We will send a copy of the patent to the name and
address as shown below.
Bidder Name:
Mailing Address:
City:
State:
Zip Code:
Representative Name: Phone number:
(include area code)
Relationship to bidder:
(Self, Agent, Attorney-in-fact, President, etc.)
Signature
Date:
(mm/dd/yyyy)
For BLM Use Only:
Date of Land Sale:
Bid guarantee deposit received:
(mm/dd/yyyy)
Bid Number:
Type of identification:
Identification Number:
(Driver’s License, State Identification or Passport)
(Continued on page 2)
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signature
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