Form 3-2461 Waiver of Appraisal Requirement

FWS Form 3-2461 (05/2020) OMB Control No. 1018-####

U.S. Fish and Wildlife Service Expiration Date ##/##/####

WAIVER OF APPRAISAL REQUIREMENT

«OwnerFullName» hereby releases the U.S. Department of the Interior, Fish and Wildlife Service, from the obligation of obtaining an appraisal, as required by 49 CFR 24.102(c)(2), with regards to the following real property:

Situated and lying in the County of «AcqCounties», State of «AcqStatesFullNames», containing «UseAcres» acres, more or less, and particularly described as the «TractName» tract («AcqTractSubAlpha») on attached Exhibit “A”.

Dated this day of , 20 .

«OwnerFullName»

By:

Its:

EXHIBIT “A”

«TractName»

(«AcqTractSubAlpha»)

«ProjectName»

«AcqCounties» County, «AcqStatesFullNames»

«AcqLegalDescription»

The above described tracts of land are delineated on a plat designated «TractName» («AcqTractSubAlpha»), bearing the date of MONTH XX, YEAR, which was prepared using field and land survey information on file in the Office of the Regional Director, Region 3, U.S. Fish and Wildlife Service, and is incorporated herein by reference.

PAPERWORK REDUCTION ACT STATEMENT: In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information about the property owner and location, and grants permission to enter and inspect the property for real estate acquisition purposes, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. Information requested in this form is required to obtain or retain a benefit. 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 currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1018-####.

ESTIMATED BURDEN STATEMENT: We estimate public reporting for this collection of information to average 30 minutes for individuals/private sector respondents and 2 hours for government respondents, including 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 the form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.