Fillable Form 4130-1b: GRAZING APPLICATION SUPPLEMENTAL INFORMATION be obtained (Bureau of Land Management - Main Domain)

Fill Online, Printable, Fillable, Blank Form 4130-1b: GRAZING APPLICATION SUPPLEMENTAL INFORMATION be obtained (Bureau of Land Management - Main Domain) Form

Use Fill to complete blank online BUREAU OF LAND MANAGEMENT - MAIN DOMAIN (CO) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 4130-1b: GRAZING APPLICATION SUPPLEMENTAL INFORMATION be obtained (Bureau of Land Management - Main Domain)

On average this form takes 28 minutes to complete

The Form 4130-1b: GRAZING APPLICATION SUPPLEMENTAL INFORMATION be obtained (Bureau of Land Management - Main Domain) form is 4 pages long and contains:

  • 2 signatures
  • 27 check-boxes
  • 91 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bureau of Land Management - Main Domain

BROWSE BUREAU OF LAND MANAGEMENT - MAIN DOMAIN (CO) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
(Form 4130-1b)
                                         
 
                                       
         
                                       
                       
                                             
               
                                           
                                           
                                         
             
                                         
                             
                               
                                     
                               
                           
Form 4130-1b
(January 2018)
UNITED STATES
DEPARTMENT OF THE INTERIOR
FORM APPROVED
OMB NO. 1004-0041
Expires: 12/31/2020
BUREAU OF LAND MANAGEMENT
FOR BLM USE ONLY
GRAZING APPLICATION
SUPPLEMENTAL INFORMATION
State:
Ofce:
Auth. Number:
Date Filed:
INSTRUCTIONS: An applicant for a permit/lease that is based on preference should complete this form and submit to the Bureau of
Land Management (BLM) along with completed forms 4130-1a (Grazing Preference Application and Preference Transfer Application)
and 4130-1 (Grazing Schedule-Grazing Application). Form 4120-8 (Assignment of Range Improvements) is used to accept assignment
of interest and responsibility for maintenance of range improvements used in conjunction with the subject preference. Form 4120-8 can
be obtained only from your local BLM Ofce. Current permittees or lessees can use Form 4130-1b to update/supersede previously
submitted information. BLM retains original in case record and returns a copy to the permittee/lessee.
APPLICANT NAME: MAILING ADDRESS:
1. APPLICANT ADDITIONAL QUALIFICATIONS STATEMENT
Complete when submitting application for a new grazing permit/lease.
This section documents whether you meet requirements, besides owning or controlling base property, to qualify for grazing use
on public lands.
a. The applicant is a: (check only one)
i. [  ]  United States citizen, (or, has properly led a valid declaration of intention to become a citizen or a valid petition for
naturalization); or,
ii. [  ]  Group or association authorized to conduct business in the State in which the grazing use is sought, all members of
which are qualied under “a(i)”; or,
iii. [  ]  A corporation authorized to conduct business in the State in which the grazing use is sought. For group or association,
or corporation, indicate the State(s) where it is a registered business entity: ______________________________.
b. Answer the following:
Has the applicant or any afliate had any Federal grazing permit or lease cancelled for violation of the permit or lease within 36
months immediately preceding the date of this application? (See 43 CFR 4100.0-5 for denition of “afliate.”)
[ ] Yes [ ] No
Has the applicant or any afliate had any State grazing permit or lease, for lands within allotments for which a Federal grazing
permit or lease is sought, cancelled for violation of the permit or lease within 36 months immediately preceding the date of this
application?
[ ] Yes [ ] No
Is the applicant or any afliate barred from holding a Federal grazing permit or lease by a court of competent jurisdiction?
[ ] Yes [ ] No
BLM requires that you submit all relevant information we request in order to determine that you meet all qualications, such as
documentation of incorporation or of group / business association, including information regarding business organization and
ownership.
(Continued on Page 2)
Save
Print
Clear
     
                                           
             
   
                   
             
                                               
                                               
                                           
                                               
                                               
                                      
                               
                   
                               
                                     
                   
                                     
                               
2. OWNERSHIP AND CONTROL OF LIVESTOCK
Complete with application for new permit/lease or to update information regarding an existing permit/lease. If under 43 CFR 4130.7
et seq. a livestock control agreement is required, failure to le it may result in civil and/or criminal regulatory enforcement actions.
a. The livestock to be grazed under the grazing permit /lease requested by this application (or under my existing permit/lease) are or
will be owned by (check all that apply):
applicant (or permittee/lessee);
other party (except for sons and daughters of applicant or permittee/lessee). If checked, you must complete part 2(b).
sons and/or daughters of applicant (or of permittee/lessee); (If checked , please answer the next two questions.)
i. Are the sons/daughters participating in educational or youth programs related to animal husbandry, agribusiness or rangeland
management, or are they actively involved in the family ranching operation and are establishing a livestock herd with the
intent of assuming part or all of the family ranching operation?
[ ] Yes [ ] No
ii. Will the livestock owned by the sons/daughters comprise 50 percent or less of the total number of livestock authorized
to occupy public lands under the permit/lease requested by this application (or under your existing permit/lease)?
[ ] Yes [ ] No
If you answered no to either or both of the immediately preceding questions, you must complete part 2(b).
b. Based on the information you provided in part 2(a), you are required to le with BLM the agreement that gives you (the applicant
or permittee/lessee) control of the livestock that you do not own that will graze under your permit or lease. This agreement must list the
kind and number of livestock subject to the agreement, state who owns them, contain the terms for their care and management, specify
the duration of the agreement and be signed by the parties to the agreement. BLM must approve the agreement prior to any grazing use.
You must also le with BLM the brands and other identifying marks of the livestock subject to the agreement. (See 43 CFR 4130.7 (d),
(e) and (f).)
This  agreement  is  (check  one):  [  ]  attached  [  ]  is  not  attached  but  will  be  submitted  to  BLM  by  (date): .
c. The brands and/or other identifying marks of the livestock that will be grazed under the permit or lease requested by this
application (or the existing permit or lease) are described as follows:
STATE(S) WHERE BRAND(S) IS REGISTERED:
BRAND NAME:
BRAND IS REGISTERED TO (Name):
IN THE SPACE BELOW, SKETCH BRAND(S), LOCATION, EARMARKS, AND ANY OTHER IDENTIFYING MARKINGS
(e.g. DEWLAP / WATTLE):
(Continued on Page 3)
(Form 4130-1b, Page 2)
     
                                     
                     
                                           
                               
                                     
                   
                                           
         
                   
     
3. OWNERSHIP OR CONTROL OF UNFENCED PRIVATE LAND LOCATED WITHIN BLM ALLOTMENTS
Complete with application for new permit/lease or to update information regarding an existing permit/lease. This information helps
BLM account for forage produced on controlled private lands when processing a grazing fee bill.
Does the applicant (or permittee/lessee) own or control (e.g. lease) unfenced private land within BLM allotments that is or will
be used in conjunction with the permit or lease requested by this application?
[ ] Yes [ ] No (If yes, provide the information below. If necessary, attach additional sheets. NOTE: Use Section 5 of this form to
report other Federal, or State or local government grazing permits and leases).
If Yes, may BLM enter this land to estimate its livestock grazing capacity and for other lawful purposes?
[ ] Yes [ ] LAND IS LEASED AND APPLICANT HAS NO AUTHORITY TO GRANT ENTRY PERMISSION [ ] No
(NOTE: If BLM cannot verify this land’s livestock grazing capacity, BLM will not take into account any forage for livestock that occurs
on it when calculating the number of livestock BLM authorizes to graze under the permit or lease.)
PROPERTY NAME
NUMBER OF ACRES
LEGAL DESCRIPTION OF OWNED/
CONTROLLED PROPERTY
LAND IS IN THIS BLM ALLOTMENT
NAME and NUMBER
OWNED LEASED TNSHP. RGE. SEC. SUBDIVISION. MERIDIAN
4. OTHER BLM GRAZING PERMITS or LEASES
Complete with application for new permit/lease or to update information regarding an existing permit/lease.
Does the applicant (or permittee/lessee) have a BLM grazing permit or lease issued by another BLM district or eld ofce?
[ ] Yes (If yes, provide the information below. If necessary, attach additional sheets). [ ] No
DISTRICT OR FIELD OFFICE NAME ALLOTMENT NAME AND NUMBER FORAGE AMOUNT AUTHORIZED (AUM’s)
5. OTHER FEDERAL, STATE AND LOCAL AGENCY GRAZING AUTHORIZATIONS
Complete with application for new permit/lease or to update information regarding an existing permit/lease.
Does the applicant (or permittee/lessee) have a grazing permit, lease or other authorization to graze on land administered by a state or
county agency, or another federal agency?
[ ] Yes (If yes, provide the information below. If necessary, attach additional sheets.) [ ] No
AGENCY NAME
GRAZING AREA or
ALLOTMENT NAME
LIVESTOCK
NUMBER /
KIND
PERIOD OF USE
FORAGE AMOUNT
(AUM’s)
BEGIN DATE END DATE
(Continued on Page 4)
(Form 4130-1b, Page 3)
     
                                   
                                       
               
                                       
     
                                               
                             
                 
                         
                                       
                                     
                                                 
 
                               
                                           
                                     
                                     
                                           
                     
         
   
         
   
6. DESIGNATION OF AUTHORIZED REPRESENTATIVE
Optional: For applicant (or permittee/lessee) to designate a representative of their choosing to conduct business with BLM. If
designating an authorized representative, submit with application for new permit/lease or to update information regarding an existing
permit/lease.
BLM is herein advised that until further written notice, the undersigned applicant or permittee/lessee has authorized the following
person to conduct business and otherwise represent the applicant or permittee/lessee in all matters relating to grazing use on public
lands within the jurisdiction of the __________________________________________ BLM Ofce.
AUTHORIZED REPRESENTATIVE INFORMATION:
Correspondence Mailing Address:
Printed Name and Title (as applicable) Email Address:
Authorized Representative Signature
Telephone Number(s) [e.g. Day, Night, Mobile]:
[Upon the designation of a representative and the issuance of a grazing permit or lease, grazing fee billings, ofcial correspondence
and other documents such as grazing decisions or other notices will be sent to the authorized representative acting on behalf of the
permittee or lessee. An authorized representative may not apply to transfer grazing preference on a permittee/lessee’s behalf. An
applicant or a permittee / lessee may change or cancel this designation at any time by submitting the change in writing to the BLM.]
7. APPLICANT (or PERMITTEE/LESSEE) SIGNATURE AND DATE
I will promptly notify BLM in writing of any changed circumstances that affect the accuracy or completeness of the information
recorded on this form.
SIGNATURE  (Applicant  or  Permittee/Lessee) DATE
PRINTED NAME ORGANIZATIONAL TITLE (If  applicant  or  Permittee/Lesses  is  a  Corporation  or  Group)
Title 18, U.S.C. Section 1001 makes it a crime for any person knowingly and willfully to make any department or agency of the United
States any false, ctitious or fraudulent statements of representations as to any matter within its jurisdiction.
NOTICES
The Privacy Act  and  43  CFR  2.48(d)  require  that  you  be  furnished  with  the  following  information  in  connection  with  information  requested  by  this 
form.
AUTHORITY: 43 U.S.C. 315, 316, and 1181d; 43 CFR 4100.
PRINCIPAL PURPOSE: The information is used to adjudicate applicant’s preference for public land or resources.
ROUTINE USES: In accordance with the Bureau of Land Management’s (BLM) System of Records Notice published in the Federal Register on
December 29, 2010 [Bureau of Land Management’s Range Management System—Interior, LLM–2; Notice To Amend an Existing System of Records;
Privacy Act of 1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM
public website.
EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain or retain a benet. Failure to
submit all of the requested information or to complete this form may result in delay or the rejection and/or denial of your application.
The Paperwork Reduction Act  requires  us  to  inform  you  that  BLM  collects  this  information  to  establish  preference  for  grazing  use  on  public  lands.  
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 30 minutes 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 (1004-0041), Bureau Information Collection
Clearance Ofcer (WO-630), 1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240.
(Form 4130-1b, Page 4)
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 4130-1b: GRAZING APPLICATION SUPPLEMENTAL INFORMATION be obtained (Bureau of Land Management - Main Domain)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document