Act of May 10, 1872, as amended (30 U.S.C. 22-54)
Act of December 29, 1916, as amended (39 Stat. 862)
Act of October 21, 1976, as amended (43 U.S.C.1732-35, 1782)
Act of September, 13, 1982 (31 U.S.C. 9301 et seq.)
Act of September 27, 1988 (102 Stat. 1776)
Act of April 16, 1993 (43 U.S.C. 299)
Form 3809-2
(January 2017)
OMB NO. 1004-0194
Expires: January 31, 2020
(Enter Bureau of Land Management (BLM) Serial No.) (Enter Name of State, if applicable) (“Yes”, if applicable)
; or Statewide
as principal; is held rmly bound unto the United States of America in the sum of
lawful money of the United States, which may be increased or decreased by a rider hereto executed in the same manner as this bond.
The principal, pursuant to the authority conferred by Section 1 of the Act of September 13, 1982 (31 U.S.C. 9303), does hereby constitute and
appoint the Secretary of the Interior to act as his attorney-in-fact for the purpose of negotiating the cash, letters of credit, savings accounts,
certicates of deposit, or securities. The interest accruing on the United States securities, cash, or other instruments given above, in the absence of
any default in the performance of any of the conditions, or stipulations set forth in this bond, the plan of operations/notice, must be paid to the
principal. The principal hereby, for any heirs, executors, administrators, successors, and assignees, jointly and severally, raties and conrms
whatever the Secretary will do by virtue of these presents.
The Secretary will transfer this deposit for the faithful performance of any and all of the conditions and stipulations as set forth in this bond, the plan
of operations/notice cited above, and the regulations at 43 CFR 3802 and 43 CFR 3809. In the case of any default in the performace of the
conditions and stipulations of such undertaking, it is agreed that the Secretary will have full power to assign, appropriate, apply, or transfer the
deposit, or any portion thereof, to the satisfaction of any damages, reclamation, assessments, penalties, or deciencies arising by reason of such
1. WHEREAS, the principal has an interest in a mining claim(s), mill site(s), or tunnel site(s) and/or responsibility for operations and/or reclamation
on the mining claim(s), mill site(s), or tunnel site(s) or public lands under the Acts cited in this bond; and
2. WHEREAS, the principal has led an acceptable notice with the United States Department of the Interior, BLM and/or received approval from
the BLM of the plan of operations cited above and said plan of operations/notice contains certain stipulations and conditions; and
3. WHEREAS, the principal hereby waives any right to notice of, and agrees that this bond will remain in full force and effect notwithstanding:
4. WHEREAS, the principal hereby agrees that notwithstanding the cancellation or relinquishment of any mining claim(s), mill site(s), or tunnel
site(s) covered by this plan of operations/notice, whether by operation of law or otherwise, the bond will remain in full force and effect as to the
terms and conditions of the plan of operations/notice, and obligations covered by this bond; and
5. WHEREAS, the principal agrees that in the event of any default under the plan of operations/notice and/or reclamation plan the bond may be
forfeited and, the United States, through the BLM, may commence and prosecute any claim, suit, or other proceeding against the principal
without the neccessity of joining the owner(s) of the mining claim(s), mill site(s), or tunnel site(s) covered by the plan of operations/notice; and
6. WHEREAS, if the principal fails to comply with the provisions of 43 CFR 3802 and 43 CFR 3809, the principal will also be subject to the
applicable provisions and penalties of Sections 303 and 305 of the Federal Land Policy and Management Act of 1976, as amended (43 U.S.C.
1733 and 1735). This provision will not be construed to prevent the exercise by the United States of any other legal and equitable remedy,
including waiver of the default; and
7. WHEREAS, on the faith of the foregoing promises, representations, and appointments and in consideration of this bond, the United States has
accepted the notice or approved the plan of operations referenced herein.
8. NOW, THEREFORE, the condition of this obligation is such that if said principal(s), heirs, executors, administrators, successors, or assignees
will, in all respects, faithfully comply with all of the provisions of the plan of operations/notice referenced herein, and any amendments thereto,
and the regulations at 43 CFR 3802 or 43 CFR 3809, then this obligation will be null and void; otherwise it will remain in full force and effect.
a. Any transfer(s) in while or in part, of any or all of the land covered by the plan of operations/notice further agrees to remain bound under
this bond as to the interests in the plan of operations/notice retained by the principal; and
b. Any modication of the plan of operations/notice retained by the principal; and
(Continued on page 2)
; or Nationwide
U.S. dollars ($
Executed this day of
, 20 :
State of
Subscribed and sworn to before me this
Country of By
, 20
(Print name)
(Notary Public)
(Date Commission Expires) (TIN or SSN No., if applicable)
Business Address
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, ctitious, or fraudulent statements or representations as to any matter within its jurisdiction.
THE PRIVACY ACT OF 1974 and the regulation in 43 CFR 2.48(d) require that you be furnished the following information in connection with information
required by this application.
AUTHORITY: 30 U.S.C. 22 et. seq.; 43 U.S.C. 1732(b) and 1782(c); 31 U.S.C. 9301 et seq.; CFR 3802 and 43 CFR 3809.
PRINCIPAL PURPOSE: Information is being used to establish nancial responsibility for surface disturbance on public lands.
ROUTINE USES: BLM will only disclose the information according to the regulations at 43 CFR 2.56(d).
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is necessary to obtain or retain a benet. Failure to disclose
this information may result in the BLM’s rejection of your application.
THE PAPERWORK REDUCTION ACT OF 1995 requires us to inform you that:
The BLM collects this information to grant the right to conduct exploration and mining activities on public lands.
Response to this request is required to obtain or retain a benet.
The BLM would like you to know that 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.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average about 8 hours per response, including the time for
reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any
other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0194), Bureau Information Collection Clearance Ofcer
(WO-630), 1849 C Street, N.W., Room 2134LM, Washington D.C. 20240.
If this bond is executed by a corporation, it should bear the seal of the corporation, if applicable.
(Form 3809-2, page 2)
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