Form 5-5527 Stock Counting Record

Form: 5-5527 OMB. No. 1076-0157

Expires: ___________

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS

STOCK COUNTING RECORD

__________________________________________ Reservation ____________________________________

(Name of reservation) (State)

1. Range unit or area ________________________________________________________________________________

(Name, number or legal description)

2. Date counted ___________________________________ 3. Permittee ________________________________________

4, Kind of stock (Cattle, horses, sheep, goats, other) _______________________________________________________________________

5. Number of stock ___________________________

6. Place where counted ________________________________________________________________________________________________

(describe accurately, use additional sheet if necessary. Show on attached map)

7. Brands and where located ___________________________________________________________________________________________

(Left‑shoulder, left side, etc.)

8. Owner of the Branded Livestock __________________________________________________________

9. Observations and Comments ________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I hereby certify that the above stock were counted on the date indicated and that the above is a true and correct count.

_______________________________________ _____________________________________________ _________________

Name Official title Date

_______________________________________ _____________________________________________ _________________

Name Official title Date

Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act.  It is used to establish the respective rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or retain a benefit.  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 an expiration date.  The number and expiration date are at the top right corner of the form.  An agency may not sponsor or conduct, and a person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number.  The public reporting burden is estimated to average 20 minutes per respondent.  This includes the time needed to understand the requirements, gather the information, complete the form, and submit it to the Department.  Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.