Form FS-2200-012 Waiver of Term Grazing Permit

USDA Forest Service FS-2200-012 (v08-2018)

OMB No. 0596-0003 (Exp. 9/30/2018)

Waiver of Term Grazing Permit

(Reference FSM 2230 and FSH 2209.13)

NOTE: The information requested on this form is voluntary; however, all the data requested is necessary if you wish to be considered as a qualified applicant for a grazing permit. The data is requested under authority of 5 USC 301, 36 CFR 222.3.

This WAIVER gives notice that:

WHEREAS,

     

of

     

,

hereinafter the seller, received Term Grazing Permit No.

     

from the U.S. Department of Agriculture, Forest Service on

     

, authorizing the seller to graze up to

     

head of

     

and

     

head of

     

for the period of use from

     

to

     

on the

     

Allotment(s),

     

National Forest National Grassland (‘X’ appropriate box) ; and

WHEREAS, such term grazing permit includes a priority for renewal from one term period to the next provided that the permittee has fully complied with the terms and conditions of the expiring term grazing permit; and WHEREAS, the seller may waive Term Grazing Permit Number       to the Forest Service in favor of a third party which has purchased the base property and/or permitted livestock of the seller; and WHEREAS, the Forest Service will issue a new term grazing permit to the purchaser of the seller’s base property and/or permitted livestock provided that the purchaser is eligible and qualified to hold a term grazing permit; and

WHEREAS, the seller has under date of

     

sold to

     

of

     

, hereinafter, the purchaser,

     

head of

     

which are permitted livestock and/or the following base property more particularly described below:

     

     

     

     

NOW, THEREFORE, the seller here and now surrenders unto the United States all privileges heretofore allowed

under Term Grazing Permit Number

     

, or that portion of the permit consisting of up to

     

head of

     

and

     

head of

     

, and further agrees not to apply at any future time for a renewal of the term grazing permit

herein surrendered. The seller further agrees to relinquish unto the United States any and all interest in range improvements constructed or installed by the seller on the lands described in Part 1 of the surrendered term grazing permit or portion thereof or on any other allotment on which the seller may have grazed.

Executed at

     

, State of

     

this

    

day of

     

,

    

. Subject to conditions and requirements printed on the back hereof.

     

     

(Witness)      

(Permittee)      

(Witness)

(Permittee)

(I/We) have read and agree to the conditions and requirements printed on the back hereof.

     

     

(Witness)      

(Purchaser)      

(Witness)

(Purchaser)

Confirmed and accepted for filing subject to the conditions and requirements printed on the back hereof, this

    

day of

     

,

    

.

Signature of authorized Officer      

National Forest or Grassland      

CONDITIONS AND REQUIREMENTS FOR THE ISSUANCE OF A TERM GRAZING PERMIT

BECAUSE OF PURCHASE OF PERMITTED LIVESTOCK AND/OR BASE PROPERTY

1. The current permittee must complete and execute Form 2200-012, Waiver of Term Grazing Permit. When applicable, the form must also be signed by the purchaser of the permittee’s base property and/or permitted livestock and the authorized officer. Two (2) witnesses must attest both the permittee’s and the purchaser’s signatures.

2. The permittee shall present to the Authorized Officer a properly executed and recorded or notarized bill of sale with cancelled check or receipt to document sale of permitted livestock, and/or a properly executed and recorded deed or contract to purchase base property, and any and all additional documents related to the transaction as requested by the Authorized Officer.

3. The purchaser must provide to the Authorized Officer any and all requested information to identify property upon which the application for a term grazing permit is based, and the relationship between such ranch property and the livestock to be grazed.

4. Failure to comply with the following requirements may result in disapproval of the term grazing permit application, or cancellation of the term grazing permit:

(a) Within 30 days from the date the Authorized Officer receives Form 2200-012, Waiver of Term Grazing Permit for filing, the purchased livestock must be moved from the seller’s lands to the purchaser’s lands.

(b) Purchased livestock identified on the purchaser’s term grazing permit application must have been permitted to graze under the seller’s term grazing permit at the time of purchase, Provided, that if the purchase did not occur during the permitted period of use, the purchased livestock may include those livestock which grazed under the term grazing permit during the most recent permitted period of use and any offspring which may have been retained for herd replacement. Yearlings that have grazed as part of the normal livestock operation may be considered permitted livestock.

3. A purchaser who does not desire to graze purchased livestock on National Forest System lands or other lands under Forest Service control during the permitted period of use following purchase must request permission from the Authorized Officer in writing and explain the reasons for the request, which might include culling or change in class of livestock.

4. Purchased base property identified in the purchaser’s term grazing permit application must be used as base property by the purchaser during the year immediately following the purchase.

5. Except in cases of foreclosure as described in FSM 2231.8 and FSH 2209.13, livestock and/or base property identified in a purchaser’s term grazing permit application may not revert to the seller or the seller’s heirs, agents, assigns, or anyone acting in concert with the seller, within two years of the sale.

6. The terms and conditions of all documents submitted with the application forms the basis for the issuance of the Term Grazing Permit.

Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0003. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing conditions and requirements, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Instructions for Completion of Form FS-2200-012, Waiver of Term Grazing Permit

(Reference FSM 2230 and FSH 2209.13)

Permittee Information

1. Permittee – Enter Name of permit holder who is waiving permit.

2. Address – Enter address of permit holder who is waiving permit.

3. Permit Number – Enter the identifying number of the active permit which is being waived.

4. National Forest or Grassland – Enter the name of National Forest or National Grassland of which the permit being waived is administered.

5. No. of Head (first) – Enter the number of animals

6. Cattle/Horses/Sheep (first) – Enter the appropriate livestock kind.

7. No. of Head (second) – Enter the number of animals

8. Cattle/Horses/Sheep (second) – Enter the appropriate livestock kind.

9. Period of Use. (From/To) – Enter dates (mm/dd) of the period permitted.

10. Allotment(s) – Enter the complete name of the allotment(s) which the permitted use occurs on.

11. National Forest or Grassland – Enter the name of National Forest or National Grassland of which the permit being waived is administered.

12. Permit Number – Enter the identifying number of the active permit which is being waived.

Purchaser Information

13. Date – Enter the date the sale of livestock and/or base property occurred.

14. Purchaser Name – Enter Name of the entity that purchased the livestock and/or base property.

15. Purchaser Address – Enter address of the entity that purchased the livestock and/or base property.

16. No. of Head – Enter the number of animals purchased

17. Cattle/Horses/Sheep – Enter the appropriate livestock kind purchased.

18. Base Property – Enter the legal description of the base property purchased.

Waiver Information

19. Permit Number – Enter the identifying number of the active permit which is being waived.

20. No. of Head (first) – Enter the number of animals being waived.

21. Cattle/Horses/Sheep (first) – Enter the appropriate livestock kind being waived.

22. No. of Head (second) – Enter the number of animals being waived.

23. Cattle/Horses/Sheep (second) – Enter the appropriate livestock kind being waived.

Execution of Waiver

24. Location – Enter the City where the waiver is being executed.

25. State – Enter the State where the waiver is being executed.

26. Day – Enter the day of the month the waiver is being executed.

27. Month – Enter the month the waiver is being executed.

28. Year – Enter the year the waiver is being executed.

29. Signature of Witness(s) – Enter the signature of the person witnessing the permittee’s signing.

30. Signature of Permittee(s) – Enter the signature of the person authorized to waive the permit.

31. Signature of Witness(s) – Enter the signature of the person witnessing the purchaser’s signing.

32. Signature of Purchaser(s) – Enter the signature of the person authorized to sign as the purchaser.

Confirmation

1. Day – Enter the day of the month the waiver is being executed.

2. Month – Enter the month the waiver is being executed.

3. Year – Enter the year the waiver is being executed.

4. Signature of Authorized Officer – Enter the official signature of the approving officer.

5. National Forest or Grassland – Enter the name of National Forest or National Grassland of which the permit being waived is administered.

Previous versions of this form are obsolete Page 7 of 7