Homesite Lease Application (Page 6 of 6) in pdf

Homesite Lease Application Page 6

CONSENT FORM

FOR

NAVAJO TRUST LAND

I, ______________________________________________ hereby grant consent to the Navajo Nation and the Bureau of Indian

Affairs to permit ____________________________________________and ________________________________________ to

lease one acre or less of Navajo Tribal Land within my permitted grazing / land use area for residential purposes as illustrated and

acknowledged by the Grazing Official / Land Board Member on the Homesite Lease Application.

I further waive any rights I may have to compensate for the diminishment in value of my permitted grazing / land use rights

as a result of the proposed homesite development.

Signed this __________ day of _____________________________, 20_________.

WITNESSES:

(For thumbprint use only)

X_________________________________

C#______________

__________________________________________

Grazing Permit Holder’s Signature

__________________________________________

Grazing Permit No.:____________________

Date of Issue:

____________________

ACKNOWLEDGED:

__________________________________

________________

____________________________

Grazing Official / Land Board Member

Date:

Chapter

FORM – CON06

Homesite Lease Application Page 6