Form 3510-1 Prospecting Application and Permit

Form 3510-1
(March 2010)

FORM APPROVED
OMB NO. 1004-0121
Expires: February 28, 2013

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

1. Serial Number (See Specific Instructions - Item 1)
2. What mineral(s) are you applying for?

PROSPECTING APPLICATION AND PERMIT
3a. Applicant's name

5. Legal description of land included in permit

APPLICANT DOES NOT FILL IN THIS SPACE
3b. Applicant's address

4. Give legal description of land requested (See General Instructions, Item 4)

Total acres

Rental submitted $

6.

Are the lands administered by a government agency?

7.

Are you the sole party in interest?

❏

Yes

❏

8a. Are you a citizen of the United States?

❏

Yes

❏

Yes

❏

No (If "Yes," give name of agency)

No (See Specific Instructions - Item 7)

❏

❏

Yes

10. A processing fee will be determined on a caseby-case basis. (See Specific Instructions - Item 10)

8b. Are you over the age of majority?

No

9a. Is application made for a corporation or other legal entity?
9b. Has a statement of qualification been filed?

Rental retained $

Total acres

❏

❏

Yes

❏

❏

Yes

❏

No

No (If "Yes," see Specific Instructions - Item 9a)

No (If "Yes," give file number, if "No," see regulation 43 CFR 3502)
11. Be sure to enclose the first year's advance rental computed at the rate of 50¢ per acre or fraction
thereof (See Specific Instructions - Item 11)

I CERTIFY That my interests, direct or indirect, in leases, permits, and applications therefor, do not exceed the maximum permitted by law or regulation, and that the
statements made herein are true, complete, and correct to the best of my knowledge and belief and are made in good faith.

(Signature of Applicant)

(Signature of Applicant)

(Date)

(Attorney-in-fact)

Title 18 U.S.C. Section 1001, makes 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.

DO NOT WRITE BELOW THIS LINE
PROSPECTING PERMIT
(Name of Mineral(s))
A permit for the lands in Item 5, above, is hereby issued under the ❏ Mineral
Leasing Act, 30 U.S.C. 181 et seq., ❏ Acquired Lands Leasing Act, 30 U.S.C.
351 et seq., ❏ Section 402 of Reorganization Plan No. 3 of 1946, 5 U.S.C.
Appendix 1031, ❏ Other Special Act(s) (as indicated below) and is subject to all

regulations found in 43 CFR 3500 and to the terms and conditions set forth on the
reverse hereof.
This permit, to the extent applicable, is subject to standard and/or special
stipulations. ❏ Stipulations if any are attached.
THE UNITED STATES OF AMERICA

Effective date of permit
This permit is issued for a period of

By

years

(Title)

(Continued on page 2)

(Date)

PERMIT TERMS AND CONDITIONS
Sec. 1. Rights conferred by issuance of prospecting permit. Permittee is granted
the exclusive right to prospect on and explore the lands to determine the existence
of a valuable deposit of the mineral applied for or any compound of that mineral in
accordance with the terms and conditions of the permit. Permittee must diligently
prospect the lands by core drilling or other acceptable methods. The permittee may
remove only such material as is necessary to demonstrate the existence of a
valuable mineral deposit.
Sec. 2. Operating regulations. (a) Permittee must comply with all regulations of
the Secretary of the Interior; and, as to the lands described herein under his
jurisdiction, to the regulations and orders of the Secretary of Agriculture.
(b) Permittee must comply with the provisions of the operating regulations of
the Bureau of Land Management (BLM) (43 CFR 3590) and all orders issued
pursuant thereto. Copies of the operating regulations may be obtained from the
BLM.
(c) Permittee must maintain a permit bond in the amount determined by the
BLM.
(d) Permittee must allow inspection of the premises and operations by
representatives of the Departments of the Interior, Agriculture, or other agency
administering the lands and provide for the free ingress and egress of
Government officers and users of the lands under authority of the United States.
Sec. 3. Multiple use. (a) Valid existing rights acquired prior hereto on the lands
described herein will not be adversely affected hereby.
(b) The granting of this permit will not preclude the issuance of other permits,
leases, or other development of the same lands.
(c) The permitted lands will be subject, at all times, to any other lawful uses by
the United States, its lessees, permittees, licensees, and assigns, but such use should
not materially interfere with the permittee's operations hereunder.
(d) The Government reserves the right to sell or otherwise dispose of the
surface of the permitted lands under existing law or laws hereafter enacted, insofar
as such disposal will not materially interfere with the rights of the permittee.
(e) The permittee must afford all facilities for inspection of the prospecting
work on behalf of the Secretary of the Interior or head of agency administering the
lands and to make a report, on demand, of all matters pertaining to the character,
progress, and results of such work.
(f) The permittee must observe such conditions as to the use and occupancy of
the surface of the lands as provided by law, in case any of said lands will have or
may be entered or patented with a reservation of mineral deposits to the United
States.
Sec. 4. Removal of deposits. Permittee must remove from the lands only such
deposits as may be necessary to experimental work or to establish the existence of
valuable deposits within the permit area and must keep a record of all minerals
mined.
Sec. 5. Rental. Permittee must pay an annual rental of 50 cents per acre, or
fraction thereof, but not less than $20 per year. The annual rental payment must be
made on or before the anniversary date of the permit, payable to Minerals
Management Service.
Sec. 6. Extension of permit. (a) This permit may be subject to extension under
applicable regulation upon approval by the Bureau of Land Management (BLM)
and upon the showing of entitlement hereto. (No extension may be granted for sodium
or sulphur prospecting permits.)

(b) Application for extension of this permit, where authorized by law or
regulation, must be filed in the proper BLM office at least 90 days prior to the date
of expiration of this permit. Unless such an application is filed within the time
specified, this permit will expire without notice to the permittee.
Sec. 7. Assignments. All assignments or transfers of this permit or of any interest
therein must be filed with the BLM for approval in accordance with the provisions
of the appropriate regulation and will take effect as of the first day of the month
following approval thereof, or, if transferee so requests, as of the first day of the
month during which such approval is given.
Sec. 8. Relinquishment of permit. Permittee may relinquish this permit, in whole
or part, by filing in the proper BLM office a written relinquishment which, upon
acceptance by the BLM, will be effective as of the date of filing.
Sec. 9 Termination or cancellation. (a) This permit will terminate automatically
upon failure of the permittee to pay the rental on or before the anniversary date
thereof.
(b) This permit may be cancelled in accordance with the regulations upon
failure by permittee to comply with the regulations or the provisions of the law, or
for violation of any of the terms or stipulations of the permit and exploration plan.
Such cancellation may occur if such failure or default continues for 30 days after
service of written notice thereof by the BLM.
Sec. 10. Protection of surface, natural resources, and improvements. The
permittee agrees to take such reasonable steps as may be needed to prevent
operations on the permitted lands from unnecessarily: (1) causing or contributing
to soil erosion or damaging crops, including forage, and timber growth thereon or
on Federal or non-Federal lands in the vicinity; (2) polluting air and water; (3)
damaging improvements owned by the United States or other parties; or (4)
destroying, damaging or removing fossils, historic or prehistoric ruins, or artifacts;
and upon any partial or total relinquishment or the cancellation or expiration of this
permit, or at any other time prior thereto when required and to the extent deemed
necessary by the lessor to fill any pits, ditches and other excavations, remove or
cover all debris, and so far as reasonably possible, restore the surface of the
permitted land and access roads to their former condition, including the removal of
structures as and if required. The BLM will prescribe the steps to be taken and
restoration to be made with respect to the permitted lands and improvements
thereon whether or not owned by the United States.
Sec. 11. Antiquities and objects of historic value. When American antiquities or
other objects of historic or scientific interest including but not limited to historic or
prehistoric ruins, fossils or artifacts are discovered on lands covered by this permit,
or discovered during performance of this permit, the item(s) or condition(s) will be
left intact and immediately brought to the attention of the contracting officer or his
representative.
Sec. 12. Discovery of Valuable Deposit: A permittee may file an application for
a noncompetitive lease not later than 60 days after expiration of the prospecting
permit. An applicant for a noncompetitive lease must show that a valuable deposit
of the mineral specified in the prospecting permit was discovered within the permit
area and during the life of the permit. For noncompetitive lease applications for
sodium, potassium and sulphur, it additionally must be shown that the lands are
chiefly valuable for that mineral (as opposed to nonmineral disposition of the
lands). See regulations in 43 CFR, Part 3500 for filing requirements for specific
minerals.
Sec. 13. Equal opportunity clause. This permit is subject to the provisions of
Executive Order No. 11246 of Sept. 24, 1965, as amended, which sets forth the
nondiscrimination clauses. A copy of this order may be obtained from the BLM.

Sec. 14. Special Stipulations:

(Section 14 continued on page 3)

(Form 3510-1, page 2)
14

Sec. 14. Special Stipulations (Cont.)

GENERAL INSTRUCTIONS
Number of copies. Three copies of the application, typewritten or printed plainly
and signed in ink, must be filed in the BLM office having jurisdiction for the State
in which the lands are located.

If additional space is needed to furnish any of the required information, the
information should be prepared on additional sheets (8 1/2 x 11”), initialed, and
attached to this application.

SPECIFIC INSTRUCTIONS
NOTE: After an initial review and clearance of the application, but prior to the
BLM's issuance of the prospecting permit, the applicant
will be required to file in triplicate an exploration plan reasonably designed to
determine the existence or workability of the deposit. See regulations in 43 CFR
Part 3500, for specific requirements regarding information to be included in
exploration plan.
Item 1 - Serial Number will be issued by the BLM at the time the application is
filed. Any future correspondence concerning this application/permit should
reference the serial number.

Item 9a - Application by a Corporation. If the applicant is a corporation, an officer
or authorized attorney-in-fact of the corporation must submit the information
specified in regulation 43 CFR 3502.30.
Application by an Association including a partnership. If the applicant is an
unincorporated association, the application must be accompanied by a copy of the
articles of association together with a showing as to citizenship and holdings of its
members, as are required of an individual.
Application by a trust: See regulation 43 CFR 3502.29 for specific requirements.

Item 2 - Specify mineral(s) applied for.
Item 4 - Land description: A complete and accurate description of the lands for
which the permit is desired must be given in accordance with the regulations at 43
CFR 3503. The acreage must not exceed the maximum permitted by laws or
regulations. In instances where the United States does not own a 100-percent
interest in the mineral deposits in any particular tract, the applicant should indicate
the percentage of Government ownership.
Item 7 - Party in interest: Applicant must indicate whether or not he is the sole
party in interest. If not, the applicant must submit, at the time the offer is filed, a
signed statement setting forth the names of the other interested parties. All
interested parties must furnish evidence of their qualifications to hold an interest in
this permit, if issued.
(Continued on page 4)

Item 9b - Statement of Qualifications: If information as to qualifications has been
filed previously with BLM, reference to that serial number may be made.
Item 10 - A processing fee will be charged which will be determined on a case-bycase basis under 43 CFR 3000.11.
Item 11 - Advance rental: An advance rental at the rate of 50 cents per acre, or
fraction thereof, but not less than $20 made payable to the Department of the
Interior - Bureau of Land Management must be submitted with this application.
(For example, the advance rental payment for an application covering 40.1 acres
would be $20.50).
(Form 3510-1, page 3)

NOTICES
The Privacy Act of 1974 and the regulations, in 43 CFR 2.48(d) provide that you be furnished with the following
information in connection with information required by this application.
AUTHORITY: 30 U.S.C. 181 et seq., 351 et seq.; 5 U.S.C. Appendix 1031; 43 CFR 3500
PRINCIPAL PURPOSE: BLM will use the information you provide to process your application for a permit to
prospect.
ROUTINE USES: BLM will disclose information to: (1) Appropriate Federal, State, local or foreign agencies, when
relevant to civil, criminal, or regulatory investigations or prosecutions; (2) appropriate Federal agencies when their
concurrence is required before BLM grants a right in public lands or resources: (3) a member of the public in
response to a specific request for pertinent information; (4) a congressional office in response to an inquiry made at
the request of an individual; and (5) to a consumer reporting agency to expedite collecting debts owed the
government.
EFFECT OF NOT PROVIDING INFORMATION: Filing of this application and disclosing this information is
required to obtain and a benefit. If you do not provide the information, BLM may reject your application.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to comply with the regulations at 43 CFR 3500, which implement the provisions of
the Mineral Leasing Act of 1920, as amended; the Mineral Leasing Act for Acquired Land of 1947; and Section 402
of Reorganization Plan No. 3 of 1946 or other special leasing act.
BLM uses the information to identify the applicant and the Federal lands for which the applicant seeks permission to
prospect for minerals.
Response to this request is required to obtain and keep a benefit.
BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored
information collection unless its displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 5 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 (1004-0121), Bureau Information Collection Clearance
Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C., 20240.

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(BLM Form 3510-1, page 4)