Form 4130-1b - Grazing Application Supplemental Information
Download a blank fillable Form 4130-1b - Grazing Application Supplemental Information in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 4130-1b - Grazing Application Supplemental Information with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Save
Print
Clear
Form 4130-1b
FORM APPROVED
(June 2015)
OMB NO. 1004-0041
Expires: October 31, 2017
FOR BLM USE ONLY
UNITED STATES
DEPARTMENT OF THE INTERIOR
State: ______________________________
BUREAU OF LAND MANAGEMENT
GRAZING APPLICATION
Office: _____________________________
SUPPLEMENTAL INFORMATION
Auth. Number: ______________________
Date Filed:
INSTRUCTIONS: An applicant for a permit/lease that is based on preference should complete this form and submit to the Bureau of
Land Management (BLM) along with completed forms 4130-1a (Grazing Preference Application and Preference Transfer Application)
and 4130-1 (Grazing Schedule-Grazing Application). Form 4120-8 (Assignment of Range Improvements) is used to accept assignment
of interest and responsibility for maintenance of range improvements used in conjunction with the subject preference. Form 4120-8 can
be obtained only from your local BLM Office. Current permittees or lessees can use Form 4130-1b to update/supersede previously
submitted information. BLM retains original in case record and returns a copy to the permittee/lessee.
APPLICANT NAME:
MAILING ADDRESS:
1. APPLICANT ADDITIONAL QUALIFICATIONS STATEMENT
Complete when submitting application for a new grazing permit/lease.
This section documents whether you meet requirements, besides owning or controlling base property, to qualify for
grazing use on public lands.
a. The applicant is a: (check only one)
i. [ ] United States citizen, (or, has properly filed a valid declaration of intention to become a citizen or a valid petition for
naturalization); or,
ii. [ ] Group or association authorized to conduct business in the State in which the grazing use is sought, all members of which
are qualified under “a(i)”; or,
iii. [ ] A corporation authorized to conduct business in the State in which the grazing use is sought. For group or association, or
corporation, indicate the State(s) where it is a registered business entity: ______________________________.
b. Answer the following:
Has the applicant or any affiliate had any Federal grazing permit or lease cancelled for violation of the permit or lease within 36
months immediately preceding the date of this application? (See 43 CFR 4100.0-5 for definition of “affiliate.”)
[ ] Yes [ ] No
Has the applicant or any affiliate had any State grazing permit or lease, for lands within allotments for which a Federal grazing
permit or lease is sought, cancelled for violation of the permit or lease within 36 months immediately preceding the date of this
application? [ ] Yes [ ] No
Is the applicant or any affiliate barred from holding a Federal grazing permit or lease by a court of competent jurisdiction?
[ ] Yes [ ] No
BLM requires that you submit all relevant information we request in order to determine that you meet all qualifications, such as
documentation of incorporation or of group / business association, including information regarding business organization and
ownership.
(Continued on page 2)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Oa 141 S - Motor Carrier Certificate Or License Application Supplement Information Release Authorization
Legal
Form Op-236 - Schedule A - Supplemental Information For Real Estate Conveyance Tax Return - 2007
Financial
Related Categories
Parent category: Legal