OMB No. 1076-0157
Expires: 3/31/2023
DEPARTMENT OF THE INTERIOR
LIVESTOCK CROSSING PERMIT
Agency: _________________________________
Reservation: ______________________________
Permission is hereby granted to:
_____________________________________
_____________________________________
_____________________________________
to drive livestock across the above reservation entering the reservation on ___/___/______, and exiting
no later than ___/___/______, and using the following route: _________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
This permit is subject to all applicable state and federal laws and regulations dealing with quarantine and
the movement of livestock and to such special instructions as may be issued by the Agency
Superintendent or his/her duly authorized representative. No authority is granted to cross trust Indian
lands unless specifically set out in this permit. In consideration of the permission granted herein, the
permittee shall pay in advance the sum of $___________.
Issued at the above Agency this ______ day of __________, ______.
_____________________________________________
_____________________________________________
Paperwork Reduction Act: This information is collected to manage agriculture and grazing leases. The information
is supplied by a respondent to obtain or retain a benefit, that is, a lease. It is estimated that responding to the request
will take an average of 20 minutes to complete. This includes the amount of time it takes to understand directions,
gather the information and fill out the form. If you wish to make comments on the form, please send them to the
Information Collection Control Officer, Bureau of Indian Affairs, 1849 C Street NW, Mail Stop 4603 MIB, Washington,
DC 20240. Note: comments, names and addresses of commentors are available for public review during regular
business hours. If you wish us to withhold this information, you must state this prominently at the beginning of your
comment. We will honor your request to the extent allowable by law. 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 expiration date. The number and expiration date are at the top right corner of the form. Please note that
an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
there is a valid OMB clearance number.
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