Form Co-8151-6 - Request For Modification Of Cultural Resource Use Permit

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Permit Number
United States
Department of the Interior
Bureau of Land Management
Colorado State Office
(Form CO-8151-6)
REQUEST FOR MODIFICATION OF CULTURAL RESOURCE USE PERMIT
1. Name of Permittee:
2. Mailing Address, Email, Telephone Number, and Fax Number:
3. Date of Permit Issuance:
4. Nature of Requested Modification:
a. Addition of the Following Personnel:
b. Removal of the Following Personnel:
c. Change of Name or Address of Permittee To:
d. Change of Curation Facility To:
e. Extension of Time/New Requested Expiration Date:
f. Change of Location of Work To:
g. Change in Type of Work To:
5. Summary of Existing Permit Conditions:
a. Organizational Summary Dated:
b. Authorized for General Charge with Vitae Date:
c. Authorized for Direct Charge with Vitae Date:
d. Area:
e. Curation Institution, with Certification Date:
6. Signature and Date:
RECORD OF DECISION:
_____ Modification Approved
_____ with special stipulations attached
_____ Modification Denied
_____ with letter of explanation attached
Signature: ______________________________________________
Date: ____________________________

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