Form 2740-001 Recreation and Public Purposes Act Application Form

Form 2740-1
(January 2004)

FORM APPROVED
OMB No. 1004-0012
Expires: September 30, 2006

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
APPLICATION FOR LAND FOR
RECREATION OR PUBLIC PURPOSES
(Act of June 14, 1926, as amended; 43 U.S.C. 869; 869-4)

la. Applicant's name

Date

Home phone (include area code)
Business phone (include area code)

b. Address (include zip code)

2. Give legal description of lands aplied for (include metes and bounds description, if necessary)
SUBDIVISION
TOWNSHIP
SECTION

County of

3a. This application is for:
b. Proposed use is

Purchase (If lease, indicate year

Public Recreation

RANGE

MERIDIAN

Containing (acres)

State of
Lease

Serial Number
(BLM use only)

)

Other Public Purposes

4. Describe the proposed use of the land. The description must specifically identify an established or definitely proposed project. Attach a detailed plan
and schedule for development, a management plan which includes a description of how any revenues will be used, and any known environmental or
cultural concerns specific to the land.

5. If applicant is State or Political subdivision thereof, cite your statutory or other authority to hold land for these purposes.

6. Attach a copy of your authority for filing this application and to perform all acts incident thereto.
7. If land described in this application has not been classified for recreation and/or Public purposes pursuant to the Recreation and Public purposes Act,
consider this application as a petition for such classification.

(Coutinued on page 2)

8. Are all activities, facilities, services, financial aid, or other benefits as a result of your proposed development provided without regard to race, color,
No (If "no," describe the situation or activity and your plans for achieving compliance.)
religion, national origin, sex, or age?
Yes

9. Are all activities, facilities, and services constructed or provided as a result of your proposed development accessible to and usable by persons with
disabilities?
Yes
No (If "no," describe the situation or activity and the reasons for nonaccessibility).

Date

Applicant's Signature

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and willfully to make to any department or
agency of the United States any false, fictitious, or fraudulent statements or representation as to any matter within its jurisdiction.

GENERAL INSTRUCTIONS
1. Type or print plainly in ink.
2. Submit application and related plans to the BLM District or Resource Area Office
in which the land is located.

3. Study controlling regulations in 43 CFR 2740 (Sales) and 43 CFR 2912 (Leases).
4. If applicant is non-governmental association or corporation, attach a copy of your
charter, articles of incorporation or other creating authority. If this information has
been previously filed with any BLM office, refer to previous filing by date, place,
and case serial number.
5. If applicant is non-governmental association or corporation, attach a copy of your
authority to operate in the State where the lands applied for are located. If
previously filed with any BLM office, refer to previous filing by date, place, and
case serial number.

SPECIFIC INSTRUCTIONS

(Items not listed are self - explanatory)
Item

If land is surveyed, give complete legal description. If land is
unsurveyed, description should be by metes and bounds connected,
if feasible, by course and distance with a corner of public land
survey. If possible, approximate legal subdivisions of unsurveyed
lands should be stated. Acreage applied for must not exceed that
specified by regulations.
3a. Generally, title to lands will not be granted upon initial approval of
an application. In order to assure proper development or use plans,
the general practice will be to issue a lease or lease with option to
purchase after development is essentially completed. In any case,
term of lease may not exceed 20 years for non-profit organizations
or 25 years for governmental agencies, instrumentalities or political
subdivisions.
4. Leases and patents under this act are conditioned upon continuing
public enjoyment of the purposes for which the land is classified.
The plan of development, use, and maintenance must show, at a
minimum:
a. A need for proposed development by citing population trends,
shortage of facilities in area, etc.
b. That the land will benefit an existing or definitely proposed
public project authorized by proper authority.
c. Type and general location of all proposed improvements,
including public access (roads, trails, etc.). This showing may
take the form of inventory lists, maps, plats, drawings, or

2.

Item

blueprints in any combination available and necessary to describe
&shed project. Site designs should be provided for intensive
the finished
use sites and general information about improvements existing or
planned on lands within the overall project.
d. An estimate of the construction costs, how the proposed project
will be financed, including a list of financial sources, and an
estimated timetable for actual construction of all improvements
and facilities.
e. A plan of management to include operating rules, proposed source
and disposition of revenues arising from the proposed operation,
personnel requirements, etc.
f. A specific maintenance plan to include, for example, sewage and
garbage disposal, road maintenance, upkeep and repair of grounds
and physical facilities, etc.
g. Applications for solid waste disposal sites must comply with
guidelines established by the Environmental Protection Agency
(40 CFR 258) and must include a detailed physical description of
the site including a map, description of ground water situation, soil
characteristics and management plan.
6. This may consist of a copy of a delegation of authority, resolution or
other evidence of authority from the governing board of the
applicant's organization, copy of the by-laws of the organization, or
the like.
(Form 2740-1, page 2)

NOTICE
The Privacy Act of 1974 and the regulation in 43 CFR 2.48 (d) provide that you be
furnished the following information in connection with information required by this
application for a Land Use Authorization.
AUTHORITY: 43 U.S.C. 869 et seq.; 43 CFR Part 2740
PRINCIPAL PURPOSE: The information is to be used to process your application.
ROUTINE USES: (1) The adjudication of the applicant's request for a Land Use
Authorization. (2) Documentation for public information. (3) Transfer to appropriate
Federal agencies when concurrence is required prior to granting a right in use of public
lands or resources. (4) (5) Information from the record and/or the record will be
transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil,
criminal or regulatory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is
mandatory for processing of the application. If all the information is not provided, the
application may be rejected.
BLM would like you to know that you do not have to respond to this or any other Federal
agency-sponsored information collection unless it displays a currently valid OMB control
number.

BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 40 hours per response,
including the time for reviewing instructions, gathering and maintaining data, and
completing and reviewing the form. Direct comments regarding the burden estimate or
any other aspect of this form to U.S. Department of the Interior, Bureau of Land
Management, (1004-0012), Bur
Bureau Information Collection Clearance Officer,
(WO-630), 1849 C Street N.W., Washington, D.C. 20240.
(WO-630),

PAPERWORK REDUCTION ACT STATEMENT
The Paperwork Reduction Act of 1995 requires us to inform you that:
Information is being collected to process your request for Federal lands under the
provisions of June 14,1926 (43 U.S.C. 869 as amended), Recreation and Public Purposes
Act.
Information will be used to illustrate whether the applicant meets requirements of
regulations found in 43 CFR Subpart 2740.
Response to this request is mandatory, see regulations found in 43 CFR Subpart 2741.4.

(Form 2740-1, page 3)