And I do hereby:
- grant the grazing permittee(s) reasonable access to exercise any and all privileges granted through their
permit to graze livestock on the above allotments;
- grant reasonable access to BIA personnel to administer grazing permits on the above lands and to
exercise the Bureau’s trust responsibility to protect and manage Indian trust lands;
- recognize that this authority will remain in effect until the ownership interest changes, the land is removed
from trust status, or this authority is revoked by the Indian landowner(s) through written notice to the
Superintendent. Removal of an allotment from the land schedule for a range unit will be effective
immediately if all sureties, Indian landowners, and permittee(s) agree; otherwise, the removal will be
effective on the next anniversary date of the permit. If the required written notice to permittees of the
allotment’s removal is made less than 180 days of the anniversary date of the permit, the removal of Indian
land will be effective 180 days after the date of written notice; and
- understand the grazing rental arising from permits on the above lands will be paid to the Department of the
Interior and distributed in accordance with applicable regulations of the Department of the Interior.
___________________________________________________________ _____________
Signature of Indian Landowner or Legal Representative Date
___________________________________________________________
Witness
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.
