5-5528 Livestock Crossing Permit

Grazing Permits, 25 CFR 166

Form 5-5528 Livestock Crossing Permit

OMB: 1076-0157

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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.



File Typeapplication/msword
File TitleForm 5-5528
AuthorIndian Affairs User
Last Modified ByEdington, David
File Modified2013-07-25
File Created2013-07-25

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