(Form 4130-4)
(Continued on Page 2)
, 2 0 to
Form 4130-4
(January 2018)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
FORM APPROVED
OMB NO. 1004-0041
Expires: 12/31/2020
FOR BLM USE ONLY
APPLICATION FOR EXCHANGE-OF-USE GRAZING AGREEMENT
(43 CFR 4130.6-1)
Date Filed
State Code
Ofce Code
Auth. Number
1. Name (last, rst, middle initial)
2. Address (include street, city, State, and zip code)
3.
I own/lease the following-described lands (List by legal subdivision and for those lands which are leased, indicate
the effective and expiration dates of
the lease. You may also use the location plat on page 2 to display the lands that you are offering for exchange of use).
4. The estimated average livestock carrying capacity (expressed in Animal Unit Months (AUMs)) of all lands described above is AUMs,
as rated for cattle sheep or goats horses or burros other (list animal kind).
5. These lands are situated within the Allotment, Field Ofce/District,
and are accessible and suitable for livestock grazing the same periods as the public lands. I understand that the grazing use allowed on public lands cannot
exceed the average livestock carrying capacity of the private lands offered. I will conne my livestock to the number, kind, period or periods of time,
and areas of use authorized. I herein grant administrative access to these private lands to employees of the Bureau of Land Management (BLM) for the
purposes of administering this agreement.
6. I hereby apply for the following grazing use on intermingled and adjacent public lands within the above-named allotment to be effective for a period
of years fr om ,
20
, unless sooner terminated by either part written notication.
ALLOTMENT NAME AND NUMBER
LIVESTOCK
NUMBER
AND KIND
GRAZING PERIOD
FORAGE AMOUNT
(ANIMAL UNIT MONTHS)
BEGIN DATE (mm/dd) END DATE (mm/dd)
NOTICE TO APPLICANT – BLM may issue an exchange-of-use grazing agreement (otherwise referred to as an EOU) to authorize use of public lands to
the extent of the livestock carrying capacity of the lands offered in exchange-of-use so long as the lands offered in exchange-of-use: (a) occur within the
same allotment as the grazing use to be authorized under the EOU, (b) the use authorized by the EOU is in harmony with the management objectives for
the allotment and is compatible with existing livestock operations, and (c) the EOU species terms and conditions that ensure orderly administration of the
range, including the fair and equitable sharing of the operation and maintenance of range improvements. No fee shall be charged for this grazing use. An
EOU has no priority for renewal and cannot be transferred or assigned. (43 CFR 4130.6 and 4130.6-1 (a) and (b)). If your application is approved, BLM will
issue you an EOU Grazing Agreement Authorization.
Signature of Applicant
REQUESTED BY:
Printed Name of Applicant
Date
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,
ctitious, or fraudulent statements or representations as to any matter within its jurisdiction.
FOR BLM USE ONLY
– In accordance with 43 CFR 4130.6-1, BLM has examined the private lands described in Part 1 of this agreement and has determined
that: (a) they are not fenced and are intermingled with public lands in the allotment(s); (b) the use of these lands will be in harmony with the management
objectives of the allotment(s); (c) the use of these lands is compatible with existing livestock operations on the allotment(s); and (d) the estimated average
livestock carrying capacity of these lands, as indicated by the applicant, is accurate.
APPLICATION APPROVED BY (Signature):
(BLM Manager)
(Printed Name) (Title) (Date)
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