Form 4130-1a Grazing Preference Application and Preference Transfer A

Form 4130-1a	UNITED STATES							FORM APPROVED
(xxxx 20xx)	DEPARTMENT OF THE INTERIOR							OMB NO. 1004-0041
	BUREAU OF LAND MANAGEMENT							Expires: xxxxx, 20xx
	GRAZING PREFERENCE APPLICATION							FOR BLM USE ONLY
	AND							State: __________________________________________
	PREFERENCE TRANSFER APPLICATION							Office: _________________________________________
	(Base Property Preference Attachment and Assignment							Applicant Authorization Number: ___________________
								Date Filed: ______________________________________
NOTICE: Payment to BLM for transfer processing service charge (see 43 CFR 4130.8-3) must accompany this application. You are encouraged to contact the BLM office that administers the subject grazing preference before you acquire base property and/or apply for grazing preference. All required forms that are needed to apply for grazing preference, to transfer grazing preference, and for a BLM grazing permit or lease are available at your local BLM office. FORM INSTRUCTIONS: (1) To apply for preference already attached to base property that you (transferee) recently purchased, leased or otherwise acquired legal control, and the corresponding BLM grazing permit/lease, complete page 1 of this form, BLM Form 4130-1 (Grazing Schedule – Grazing Applica­tion), and BLM Form 4130-1b (Grazing Application–Supplemental Information), and submit these forms to BLM with all documents that BLM requires to support or verify the information stated on the application forms. (2) To apply to transfer preference from base property to other property (regardless of whether the other property already is base property for a BLM grazing preference) and for a corresponding permit or lease, the transferee completes the requirements described in (1), above, and the owner or controller of the base property from which the preference is to be transferred (transferor) completes page 2 of this form. Applicants must obtain all other needed signatures as applicable (e.g. lien-holder consent) to complete the application. Upon receipt of an application for preference or an application to transfer preference, BLM will provide the parties to the transfer with an Assignment of Range Improvements (BLM Form 4120-8) for their completion as applicable.
PREFERENCE APPLICANT (TRANSFEREE) INFORMATION
Name:						Mailing Address:
REQUESTED PREFERENCE ATTACHMENT TO BASE PROPERTY
I offer the [ ] land [ ] water described below to meet the mandatory base property qualification in support of my application for grazing use on public lands. I request that BLM confirm the current attachment of, or request that BLM attach, grazing preference to this property as shown below and assign said preference to me for grazing use on public lands based on my ownership or control of this property. I certify that this property is described correctly and that it meets the requirements of the grazing regulations (43 CFR 4110.2-1(a) or (b), as applicable). You must submit a copy of documentation that you own or control this property (e.g. deed, lease) with this form. If needed, attach clearly labeled additional sheets.
Offered Base Property Land (or Water)			Number of Base Property Acres by Status (Or Number of Livestock Served by Water Type)			Grazing Preference Attached or Requested to be Attached To Offered Base Property (Under 43 CFR 4110.2-2(c))				Forage Amount (AUM’s) and Use Status
Property Name and Legal Description (If water base, also describe type of water (e.g. well, spring) and list State Permit/Certificate Numbers)			Owned (Full)	Controlled (Part/Availability*)		For Grazing Use In: Allotment Number and Name				Active	Suspended
Preference Applicant (Transferee) Signature:				Printed Name:						Date
*NOTE: If part-time water, indicate period of year that it is available for livestock use.
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.
IMPORTANT INFORMATION: Upon BLM approval of this application, BLM will update its records to reflect the change in preference holders and/or attachments of preference to base property. BLM will act upon the application for the grazing permit or lease concurrently through a separate process which will include a review and possible change to the terms and conditions of grazing use from that authorized to the previous preference holder. On a regional basis, BLM land use plans identify those public lands that are available for grazing use under a permit or lease. The terms and conditions of such permits and leases are periodically changed in response to management needs or circumstances.
(Continued on page 2)

OMB NO. 1004-0041

Expires: October 31, 2017

APPLICATION TO TRANSFER GRAZING PREFERENCE FROM BASE PROPERTY

To Be Completed by TRANSFEROR:  I, (Print Transferor Name), ____________________________________________, herein request that BLM transfer grazing preference, as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY below, to property owned or controlled by the preference applicant (transferee) that is listed on page 1 of this form. I understand that upon BLM approval of this transfer request, my grazing permit or lease is terminated automatically and without further notice to the extent of the transferred preference. If I am not applying to transfer my preference in total, then I also am submitting with this application a completed Grazing Schedule - Grazing Application (BLM Form 4130-1) to apply for a grazing permit or lease that reflects my remaining preference. I hereby assign to the transferee my interest and/or maintenance responsibility in authorized range improvements on public lands used and maintained in conjunction with the below-listed preference as shown on the enclosed Assignment of Range Improvements (BLM Form 4120-8). I (check one): [ ] own [ ] control the property described below. If transferor controls but does not own the property shown below, the transferor must obtain the consent of the base property owner, as follows. The base property owner consents to the transfer of preference as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY below as attested by the following signature(s):

(Signature(s) of Owner(s))

(Date)

(Printed Name(s) of Owner(s))

The property described below (check one): [ ] is [ ] is not encumbered by a lien. If the property shown below is encumbered by a lien, the transferor must obtain the consent of the base property lien holder, as follows. The base property lien holder(s) consent(s) to the transfer of preference as shown in the REQUEST TO TRANSFER PREFERENCE FROM BASE PROPERTY below as attested by the following signature(s):

(Signature(s) of Lien Holder(s))

(Date)

(Printed Name(s) of Lien Holder(s))

REQUEST TO TRANSFER GRAZING PREFERENCE FROM BASE PROPERTY (If more room is necessary, attach clearly labeled additional sheets)

Existing Base Property From Which Preference is to be Transferred Property Name and Legal Description (If water base, also describe type of water (e.g. well, spring) and list State Permit/Certificate Numbers)

Number of Acres and Status

Summary of Request to Transfer Public Land Forage Preference from Base Property – Amount (AUM’s) and Use Status

(or Number of Livestock Served by Water Type*)

Current Preference Attachment

Preference requested to be transferred**

Preference attachment after transfer approval

Affects Transferor’s BLM Permit or Lease to Graze in:

Owned (Full)

Controlled (Part/Avail*)

Active AUM’s

Suspended AUM’s

Active AUM’s

Suspended AUM’s

Active AUM’s

Suspended AUM’s

Allotment Name

No.

Transferor Signature:

Date:

* If part-time water, indicate period of year it is available for livestock use. ** Forage amount requested to be transferred: Enter amount here and in the appropriate columns on page 1.

NOTICES -The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with information requested by this form. AUTHORITY: 43 U.S.C. 315, 316, and 1181d; 43 CFR 4100. PRINCIPAL PURPOSE: The information is used to adjudicate ap­plicant’s preference for public land or resources. ROUTINE USES: In accordance with the Bureau of Land Management’s (BLM) System of Records Notice published in the Federal Register on December 29, 2010 [Bureau of Land Management’s Range Management System—Interior, LLM–2; Notice To Amend an Existing System of Records; Privacy Act of 1974; as Amended], names and addresses provided by the applicant on this form will be publically available in reports on the BLM public website. EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the requested information is necessary to obtain or retain a benefit. Failure to submit all of the requested information or to complete this form may result in delay or the rejection and/or denial of your application. The Paperwork Reduction Act requires us to inform you that BLM collects this information to establish preference for grazing use on public lands. 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. BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average 35 minutes per re­sponse, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0041), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240.

For BLM Use Only

BLM ACTION ON APPLICATION: I approve the preference recording and assignment as applied for on page 1 of this form and, if applicable, approve the preference transfer and range improvement assignment as applied for on page 2 of this form. This action does not authorize grazing use on public lands. BLM will, by separate action address, issue or modify the grazing permits/lease that arise from or are affected by approval of this application.

(BLM Manager’s Signature)

(Date)

(BLM Manager’s Printed Name)

(Title)

(BLM Office Name/Organizational Code)

(Form 4130-1a, page 2)