5-5528 Livestock Crossing Permit

Form 5-5528		OMB No. 1076-0157 Expires: ##/##/####
	UNITED STATES
	DEPARTMENT OF THE INTERIOR
	BUREAU OF INDIAN AFFAIRS
	LIVESTOCK CROSSING PERMIT

Agency: _________________________________
Reservation: ______________________________

Permission is hereby granted to:

_____________________________________	of	_____________________________________
(Name)		_____________________________________
		(Address)

to drive livestock across the above reservation entering the reservation on ___/___/______, and exiting no later than ___/___/______, and using the following route: _________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

This permit is subject to all applicable state and federal laws and regulations dealing with quarantine and the movement of livestock and to such special instructions as may be issued by the Agency Superintendent or his/her duly authorized representative. No authority is granted to cross trust Indian lands unless specifically set out in this permit. In consideration of the permission granted herein, the permittee shall pay in advance the sum of $___________.

Issued at the above Agency this ______ day of __________, ______.

Approved:	Accepted:
_____________________________________________	_____________________________________________
(Superintendent)	(Permittee)

Paperwork Reduction Act: 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 commentors 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 your request 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.