Form 4130-1a Grazing Preference Application and Preference Applicatio

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Form 4130-1a
(August 2007)

FORM APPROVED
OMB NO. 1004-0041
Expires: March 31, 2008

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

FOR BLM USE ONLY

GRAZING PREFERENCE APPLICATION

State: ________________________________________________

AND

Office: _______________________________________________

PREFERENCE TRANSFER APPLICATION
(Base Property Preference Attachment and Assignment)

Applicant Authorization Number: _________________________
Date Filed: ___________________________________________

NOTICE: Payment to BLM for transfer processing service charge (see 43 CFR 4130.8-3) must accompany this application. You are encouraged to contact
the BLM office that administers the subject grazing preference before you acquire base property and/or apply for grazing preference. All required forms
that are needed to apply for grazing preference, to transfer grazing preference, and for a BLM grazing permit or lease are available at your local BLM
office. FORM INSTRUCTIONS: (1) To apply for preference already attached to base property that you (transferee) recently purchased, leased or otherwise
acquired legal control, and the corresponding BLM grazing permit/lease, complete page 1 of this form, BLM Form 4130-1 (Grazing Schedule – Grazing Application),
and BLM Form 4130-1b (Grazing Application–Supplemental Information), and submit these forms to BLM with all documents that BLM requires to support or verify
the information stated on the application forms. (2) To apply to transfer preference from base property to other property (regardless of whether the other property
already is base property for a BLM grazing preference) and for a corresponding permit or lease, the transferee completes the requirements described in (1), above, and
the owner or controller of the base property from which the preference is to be transferred (transferor) completes page 2 of this form. Applicants must obtain all other
needed signatures as applicable (e.g. lien-holder consent) to complete the application. Upon receipt of an application for preference or an application to transfer
preference, BLM will provide the parties to the transfer with an Assignment of Range Improvements (BLM Form 4120-8) for their completion as applicable.

PREFERENCE APPLICANT (TRANSFEREE) INFORMATION
Name:

Mailing
Address:
REQUESTED PREFERENCE ATTACHMENT TO BASE PROPERTY

I offer the
land
water described below to meet the mandatory base property qualification in support of my application for grazing use on public
lands. I request that BLM confirm the current attachment of, or request that BLM attach, grazing preference to this property as shown below and assign
said preference to me for grazing use on public lands based on my ownership or control of this property. I certify that this property is described correctly and
that it meets the requirements of the grazing regulations (43 CFR 4110.2-1(a) or (b), as applicable). You must submit a copy of documentation that you own or control
this property (e.g. deed, lease) with this form. If needed, attach clearly labeled additional sheets.
Offered Base Property

Land (or Water)

Number of Base Property Acres by
Status

Property Name and Legal Description

(Or Number of Livestock
Served by Water Type)

(If water base, also describe type of water (e.g. well,
spring) and list State Permit / Certificate Numbers)

Owned

Controlled

(Full)

(Part/Availability*)

Preference Applicant (Transferee) Signature:

Grazing Preference
Attached or Requested to be Attached
to Offered Base Property
(Under 43 CFR 4110.2-2(c))

For Grazing Use In:
Allotment Number and Name

Forage Amount (AUM’s)
and Use Status
Active

Suspended

Date:

*NOTE: If part-time water, indicate period of year that it is available for livestock use.
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 representations as to any matter within its jurisdiction.

IMPORTANT INFORMATION: Upon BLM approval of this application, BLM will update its records to reflect the change in preference holders and/or attachments
of preference to base property. BLM will act upon the application for the grazing permit or lease concurrently through a separate process which will include a review
and possible change to the terms and conditions of grazing use from that authorized to the previous preference holder. On a regional basis, BLM land use plans identify
those public lands that are available for grazing use under a permit or lease. The terms and conditions of such permits and leases are periodically changed in response to
management needs or circumstances.
(Continued on page 2)

For BLM Use Transferor Authorization Number:

_________________________

APPLICATION TO TRANSFER GRAZING PREFERENCE FROM BASE PROPERTY
To Be Completed by TRANSFEROR:
I, (Print Transferor Name) ________________________________________________________, herein request that BLM transfer grazing preference, as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY
below, to property owned or controlled by the preference applicant (transferee) that is listed on page 1 of this form. I understand that upon BLM approval of this transfer request, my grazing permit or lease is terminated automatically and
without further notice to the extent of the transferred preference. If I am not applying to transfer my preference in total, then I also am submitting with this application a completed Grazing Schedule - Grazing Application (BLM Form 4130-1)
to apply for a grazing permit or lease that reflects my remaining preference. I hereby assign to the transferee my interest and/or maintenance responsibility in authorized range improvements on public lands used and maintained in
conjunction with the below-listed preference as shown on the enclosed Assignment of Range Improvements (BLM Form 4120-8).

I (check one):
own
control the property described below. If transferor controls but does not own the property shown below, the transferor must obtain the consent of the base property owner, as follows.
The base property owner consents to the transfer of preference as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY below as attested by the following signature(s):
_______________________________________________________________
(Signature(s) of Owner(s))

____________________________
(Date)

______________________________________________
(Printed Name(s) of Owner(s))

The property described below (check one):
is
is not encumbered by a lien. If the property shown below is encumbered by a lien, the transferor must obtain the consent of the base property lien holder, as follows.
The base property lien holder(s) consent(s) to the transfer of preference as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY below as attested by the following signature(s):
_______________________________________________________________
(Signature(s) of Lien Holder(s))

_____________________________
(Date)

______________________________________________
(Printed Name(s) of Lien Holder(s))

REQUEST TO TRANSFER GRAZING PREFERENCE FROM BASE PROPERTY (If more room is necessary, attach clearly labeled additional sheets)
Existing Base Property
From Which Preference is to be Transferred

Property Name and Legal Description
(If water base, also describe type of water (e.g. well,
spring) and list State Permit / Certificate Numbers)

Number of Acres and Status
(or Number of Livestock Served
by Water Type*)
Owned
(Full)

Controlled
(Part / Avail.*)

Transferor Signature:

Summary of Request to Transfer Public Land Forage Preference from Base Property - Amount (AUM’s) and Use Status
Current Preference
Attachment
Active
AUM’s

Suspended
AUM’s

Preference requested to
be transferred**
Active
AUM’s

Suspended
AUM’s

Preference attachment
after transfer approval
Active
AUM’s

Suspended
AUM’s

Affects Transferor’s BLM Permit or Lease
to Graze in:
Allotment Name

No.

Date:

* If part-time water, indicate period of year it is available for livestock use.

** Forage amount requested to be transferred: Enter amount here and in the appropriate columns on page 1.

NOTICES – The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) and the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.) provide that you be furnished the following information in connection with information required by this application. AUTHORITY: 43 U.S.C. 315, 316,
and 1181d; 43 CFR 4100. PRINCIPAL PURPOSE: The information is used to adjudicate applicant’s preference for public land or resources. ROUTINE USES: BLM will only disclose the information according to the regulations at 43 CFR 2.56. EFFECT OF NOT PROVIDING
INFORMATION: Disclosure of this information is necessary to receive a benefit. Failure to disclose this information may result in BLM’s rejection of your application. The Paperwork Reduction Act of 1995 requires us to inform you that BLM collects this information to establish preference for
grazing use on public lands. BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 30 minutes 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 (1004-0041), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240. 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.

For BLM Use Only
BLM ACTION ON APPLICATION: I approve the preference recording and assignment as applied for on page 1 of this form; and, if applicable, approve the preference transfer and range improvement assignment as
applied for on page 2 of this form. This action does not authorize grazing use on public lands. BLM will, by separate action address, issue or modify the grazing permits/leases that arise from or are affected by
approval of this application.
____________________________________________________
____________________________________________
(BLM Manager’s Signature)
(Date)
____________________________________________________
(BLM Manager’s Printed Name)

_____________________________________________________
(Title)

________________________________________________________________
(BLM Office Name / Organizational Code)
(Form 4130-1a, page 2)