5-5520 Power of Attorney

Form 5-5520	UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF INDIAN AFFAIRS	OMB No. 1076-0157 Expires: ##/##/####
	POWER OF ATTORNEY

Pledging United States Bonds or Notes as Security for Grazing Permits

KNOW ALL MEN BY THESE PRESENTS that _________, ___________________________________,

(I or we) (Permittee)

of _______________________________________________, State of ______________, partners doing

(Mailing Address)

business under the firm name of _______________________________________ a corporation organized and existing under the laws of the State of _________________, having an office and principal place of business at _________________________________________________________ , State of in

(Mailing Address)

pursuance of a resolution of the Board of Directors of said corporation, passed on the ______ day of _____________ a duly certified copy of which resolution is attached hereto (strike out italicized reference to partners and corporation if not applicable), hereby appoint the Agency Superintendent, Bureau Of Indian Affairs and his successors in office, as attorney‑in‑fact to collect or to sell, assign, and transfer certain negotiable United States bonds, or other negotiable United States obligations described as follows:

TITLE AND SERIES	SERIAL NUMBER	AMOUNT
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________
_________________________	_________________________	_________________________,

such obligations having been deposited pursuant to authority conferred by Section 1126 of the Revenue Act of 1925, as amended, and subject to the provisions thereof and of Treasury Department Circular No. 154, dated February 6, 1935, as security for the faithful performance of any and all conditions or stipulations of a grazing permit accepted by the undersigned on Range Unit _____________ of the _______________________________ Indian Reservation for a period beginning ___/___/______ and terminating not later than ___/___/______ , attached and made a part hereof.

The undersigned agrees that in case of any default in the performance of any of the conditions or stipulations of the grazing permit, the said attorney‑in‑fact shall have full power to collect said bonds and obligations or any part thereof, or to sell, assign, and transfer said securities or any part thereof, without notice, at public or private sale, free from any equity of redemption and without appraisement or valuation, notice and right to redeem being waived, and to apply the proceeds of such sale or collections, in whole or in part, to the satisfaction of any damages, demands, or deficiencies arising by reason of such default as said attorney‑in‑fact may deem best. And ________ hereby for ___________ heirs, executors,

(I or we) (my or our)

administrators, successors and assigns, ratify and confirm whatever said attorney-in-fact shall do by virtue of these presents.

IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed and have set opposite their respective names the date of execution.

Date of Signature

____________________________ ____________________________

Permittee

____________________________ ____________________________

Permittee

State of _______________)

)ss

County of ______________)

Be it remembered, that on this __________ day of _________________, 20_____, before the undersigned, a NOTARY PUBLIC in the County and State aforesaid, personally appeared

__________________________________________________________, to me personally known to be the identical person who executed the within instrument in writing, and such person duly acknowledges the execution of the same as his or her free and voluntary act.

IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my seal on day and year last hereinabove written.

(Seal)

_____________________________________________

Notary Public

_____________________________________________

My Commission Expires:

Paperwork Reduction Act Statement: This information is collected to manage agriculture and grazing leases. The information is supplied by a respondent to obtain or retain a benefit, that is, a lease. It is estimated that responding to the request will take an average of 20 minutes to complete. This includes the amount of time it takes to understand directions, gather the information and fill out the form. If you wish to make comments on the form, please send them to the Information Collection Control Officer, Bureau of Indian Affairs, 1849 C Street NW, Mail Stop 4603 MIB, Washington, DC 20240. Note: comments, names and addresses of commenters are available for public review during regular business hours. If you wish us to withhold this information, you must state this prominently at the beginning of your comment. We will honor it to the extent allowable by law. 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 expiration date. The number and expiration date are at the top right corner of the form. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless there is a valid OMB clearance number.

Form 5-5520 – Power of Attorney, Page 2 of 2

Permittee Initial _______