2540o-2 Conveyances Affecting Color or Claim of Title

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Form 2540-2
(June 2016)

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UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

FORM APPROVED
OMB NO. 1004-0029
Expires: March 31, 2019

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

MERIDIAN

SUBDIVISION

RECORDED
GRANTOR
(a)

GRANTEE
(b)

DATE
(c)

VOL.
(d)

PAGE
(e)

COUNTY

STATE

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 Addresss)
(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 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.
(Continued on page 2)

(Form 2540-2, page 1)

GENERAL INSTRUCTIONS

1. File, in duplicate, with all color-of-title applications on Form 2540-1. T
ype 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) require that you be furnished the following information in connection with
information required by this form.
AUTHORITY: 43 U.S.C. 1068
PRINCIPAL PURPOSE: The information is to be used to process your application and to document the administrative action relating to the
application.
ROUTINE USES: In accordance with the System of Records titled, “Land and Minerals Authorization Tracking System—Interior, LLM32,” disclosure outside the Department of the Interior may be made: (1) To appropriate Federal agencies when concurrence or supporting
information is required prior to granting or acquiring a right or interest in lands or resources, (2) To Federal, State, or local agencies or
a member of the general public in response to a specific request for pertinent information, (3) To the U.S. Department of Justice or in a
proceeding before a court or adjudicative body when (a) the United States, the Department of the Interior, a component of the Department, or
when represented by the government, an employee of the Department is a party to litigation or anticipated litigation or has an interest in such
litigation, and (b) the Department of the Interior determines that the disclosure is relevant or necessary to the litigation and is compatible with
the purpose for which the records were compiled, (4) To an appropriate Federal, State, local, or foreign agency responsible for investigating,
prosecuting, enforcing, or implementing a statute, regulation, rule, or order, where the disclosing agency becomes aware of an indication of
a violation or potential violation of civil or criminal law or regulation, (5) To a member of Congress or a Congressional staff member from
the record of an individual in response to an inquiry made at the request of that individual, (6) To the Department of the Treasury to effect
payment to Federal, State, and local government agencies, nongovernmental organizations, and individuals, and (7) To individuals involved
in responding to a breach of Federal data. The BLM will only disclose this information in accordance with the Freedom of Information Act,
the Privacy Act, and the provision in 43 CFR 2.56(c).
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 requirements of regulations found in 43 CFR Subpart 2540, Subparts 25412547.
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.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is required. If all the information is not provided, the
application may result in delay or preclude the BLM’s acceptance of your form.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated at 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 the U.S. Department of the Interior, Bureau of Land Management (1004-0012), Bureau Information Collection
Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

(Form 2540-2, page 3)