Form 5-5520 Power of Attorney, Page 1 of 2
Permittee Initial _______
Form 5-5520
OMB No. 1076-0157
Expires: 3/31/2023
Pledging United States Bonds or Notes as Security for Grazing Permits
KNOW ALL MEN BY THESE PRESENTS that _________, ___________________________________,
(I or we) (Permittee)
of _______________________________________________, State of ______________, partners doing
(Mailing Address)
business under the firm name of _______________________________________ a corporation
organized and existing under the laws of the State of _________________, having an office and principal
place of business at _________________________________________________________ , State of in
(Mailing Address)
pursuance of a resolution of the Board of Directors of said corporation, passed on the ______ day of
_____________ a duly certified copy of which resolution is attached hereto (strike out italicized reference
to partners and corporation if not applicable), hereby appoint the Agency Superintendent, Bureau Of
Indian Affairs and his successors in office, as attorney-in-fact to collect or to sell, assign, and transfer
certain negotiable United States bonds, or other negotiable United States obligations described as
such obligations having been deposited pursuant to authority conferred by Section 1126 of the Revenue
Act of 1925, as amended, and subject to the provisions thereof and of Treasury Department Circular No.
154, dated February 6, 1935, as security for the faithful performance of any and all conditions or
stipulations of a grazing permit accepted by the undersigned on Range Unit _____________ of the
_______________________________ Indian Reservation for a period beginning ___/___/______ and
terminating not later than ___/___/______ , attached and made a part hereof.
The undersigned agrees that in case of any default in the performance of any of the conditions or
stipulations of the grazing permit, the said attorney-in-fact shall have full power to collect said bonds and
obligations or any part thereof, or to sell, assign, and transfer said securities or any part thereof, without
notice, at public or private sale, free from any equity of redemption and without appraisement or valuation,
notice and right to redeem being waived, and to apply the proceeds of such sale or collections, in whole
or in part, to the satisfaction of any damages, demands, or deficiencies arising by reason of such default
as said attorney-in-fact may deem best. And ________ hereby for ___________ heirs, executors,
(I or we) (my or our)
administrators, successors and assigns, ratify and confirm whatever said attorney-in-fact shall do by
virtue of these presents.
Form 5-5520 Power of Attorney, Page 2 of 2
Permittee Initial _______
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed and have set
opposite their respective names the date of execution.
Date of Signature
____________________________ ____________________________
____________________________ ____________________________
State of _______________)
County of ______________)
Be it remembered, that on this __________ day of _________________, 20_____, before the
undersigned, a NOTARY PUBLIC in the County and State aforesaid, personally appeared
__________________________________________________________, to me personally known to be
the identical person who executed the within instrument in writing, and such person duly acknowledges
the execution of the same as his or her free and voluntary act.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my seal on day and year
last hereinabove written.
Notary Public
My Commission Expires:
Paperwork Reduction Act Statement: 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 commenters 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 it 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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