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Form 2740-1
FORM APPROVED
UNITED STATES
(May 2016)
OMB NO. 1004-0012
DEPARTMENT OF THE INTERIOR
Expires: March 31, 2019
BUREAU OF LAND MANAGEMENT
Serial Number
Date
(BLM use only)
APPLICATION FOR LAND FOR
RECREATION OR PUBLIC PURPOSES
Home phone (include area code)
(Act of June 14, 1926, as amended; 43 U.S.C. 869; 869-4)
b. Address (include zip code)
Business phone (include area code)
la. Applicant’s name
2. Give legal description of lands applied for (include metes and bounds description, if necessary)
SUBDIVISION
SECTION
TOWNSHIP
RANGE
MERIDIAN
Containing (acres)
County of
State of
Purchase (If lease, indicate year
)
3a. This application is for:
Lease
b. Proposed use is
Public Recreation
Other Public Purposes
4. Describe the proposed use of the land. The description must specifically identify an established or definitely proposed project. Attach a detailed plan
and schedule for development, a management plan which includes a description of how any revenues will be used, and any known environmental or
cultural concerns specific to the land.
5. If applicant is State or Political subdivision thereof, cite your statutory or other authority to hold land for these purposes.
6. Attach a copy of your authority for filing this application and to perform all acts incident thereto.
7. If land described in this application has not been classified for recreation and/or public purposes pursuant to the Recreation and Public Purposes Act,
consider this application as a petition for such classification.
(Continued on page 2)
(Form 2740-1, page 1)