2540-2 Conveyances Affecting Color or Claim of Title

Form 2540-2
(February 2005)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

FORM APPROVED
OMB NO. 1004-0029
Expires: October 31, 2006

CONVEYANCES AFFECTING COLOR OR CLAIM OF TITLE

Serial Number
INSTRUCTIONS ON PAGE 2

Applicant's Last Name

Legal description of lands claimed
TOWNSHIP

RANGE

SECTION

SUBDIVISION

MERIDIAN COUNTY STATE

RECORDED
GRANTOR

GRANTEE

DATE

VOL.

PAGE

(a)

(b)

(c)

(d)

(e)

RESERVATIONS, RESTRICTIONS,
TYPE OF CONVEYANCE
(MORTGAGE, LEASE, FEE, ETC.)
(f)

I CERTIFY That all the above conveyances for which notation has been made as to place of recordation are of official record in the county records and that
there are no known conflicting conveyances of record.
(Signature)

(Title)

(Street Address)
(City, State, Zip code)

(Date)

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212, make it a crime for any person knowingly and wilfully to make to any department or agency
of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2)

GENERAL INSTRUCTIONS
1. File, in duplicate, with all color-of-title applications on Form

2540-1. Type or print plainly in ink.
2. Give requested specific information for each conveyance affecting
claim made, during claim period, prior to date of application.

Itemize data relating to all record and non-record title conveyances
in chronological order.

3. Form must be certified by the proper county official or an
abstracter.
4. Explain, in detail, any irregularities in any conveyance.
5 . Do not attach abstracts of title or other evidence relating to
conveyance or claim. Such data may be requested later. If
submitted, it will be returned

SPECIFIC INSTRUCTIONS
(Items not listed are self-explanatory)
(a) &
&&
(b) Give complete name of each grantor and grantee. If
grantor or grantee is acting in an official capacity (i.e.,)
sheriff, tax official, etc.) give official position title.
(c) Give date of each conveyance.
(d) & (e) Give volume and page number of recordation for each
conveyance of record.
(f) Specify nature or type of right reserved in
conveyance (i.e.,) oil and gas, all minerals, rights-of-way,
etc.). If no reservation is made, enter "none."

(Continued on page 3)

(Form 2540-2, page 2)

NOTICES
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.
AUTHORITY: 43 CFR U.S.C. 1068
PRINCIPLE PURPOSE: The information is to be used to process this application and document the administrative
action relating to the application.
ROUTINE USES: (1) The adjudication of the applicant's rights. (2) Documentation for public information in support
of notations made on land status records for the management, disposal, and use of public lands and resources. (3)
Transfer to appropriate Federal agencies when concurrence is required prior to granting a right in 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 voluntary. If all the information
is not provided, your application may be rejected.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to process your request for Federal lands under the provisions of the Color-of-Title
Regulations, found in 43 CFR Section 2540.
Information will be used to illustrate whether the applicant meets the requirements of the Act under which the
application is filed, see 43 CFR Part 2540, Subparts 2541-2547.
Response to this request is mandatory, see 43 CFR Subpart 2541.2.
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 1 hour 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 (1004-0029), Bureau Information Collection Clearance
Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

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(Form 2540-2, page 3)