OMB No. 1076-0157
Expires: 3/31/2023
Range Unit:
Contract No.:
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
ASSIGNMENT OF GRAZING PERMIT
Permittee ____________________________
Range Unit ___________________________
Contract No. __________________________
Reservation __________________________
Permit period ___/___/______ to ___/___/______
Agency _____________________________
Date Issued ___/___/______
Annual Grazing Rental $ ________________
ASSIGNMENT
I, the Permittee of record of the above-described grazing permit, including all modifications
thereto, hereby transfer, set over, and assign all my right, title and interest in and to the subject grazing
permit, subject to the approval of the Secretary of the Interior or his duly authorized representative, to
Assignee ___________________________________, effective the ____ day of __________, _______.
ACCEPTANCE
I, the Assignee in the above and foregoing assignment, made subject to the approval of the
Secretary of the Interior or his duly authorized representative, hereby accept said assignment and agree
to fulfill all the obligations, conditions, stipulations and requirements of the subject permit, and the
regulations at 25 CFR 166 and as may hereafter be amended, and hereby agree to furnish proper bond
guaranteeing faithful compliance with said permit thus assigned (Strike out bond reference if not
applicable), firmly binding myself, my heirs, executors, administrators, successors or assignees to full
compliance therewith.
Unless authorized by the officers issuing and approving this permit in writing, only livestock
bearing the brands and marks herein shown shall be grazed under authority of this assigned permit:
CATTLE BRANDS (R L) EAR MARK (R L) HORSE BRANDS (R L) SHEEP EAR MARK (R L)
WOOL MARK
Assignment Administration Fee: $__________
__________________________ ___/___/___
__________________________ ___/___/___
Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to establish the respective rights and
responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or retain a benefit. In compliance
with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a
number and an expiration date. The number and expiration date are at the top right corner of the form. An agency may not sponsor or conduct, and a
person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number. The public reporting
burden is estimated to average 20 minutes per respondent. This includes the time needed to understand the requirements, gather the information,
complete the form, and submit it to the Department. Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs
Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.
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