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Sec. 18.Effecrh-e dare-This contract becomes effective as indicated below. <br /> 0 if this contract becomes effective on the date BLM signs the contract,BLM will check this box. <br /> ❑ If this contract becomes effective only after certain conditions are met,BLl11 will check this box,list the conditions below,and <br /> Indicate the effective date. <br /> Sec. 19.Appeal-You may appeal any decision that BLM makes in regard to this contract under Parts 4 and 1840 of Title 43 of the Code of <br /> Federal Regulations. <br /> The following parties have executed this contract as of: <br /> PURCHASER THE UNITED STATES OF AMERICA <br /> P/(�Gt'l�..r2Sc G 'DWG � �. - .- . . By <br /> (Individual or Film Name <br /> --7LV 5__._.�4'�� �I G�asG._Irj,.._&t+AD <br /> (Address) (BLM) <br /> a r3tf '�lEr-mO MAAJ.6.�%il_ <br /> (Phhone Number-I�Iude area code) �. (Title) <br /> J (Signature) le <br /> (Signature) <br /> ifyou are a corporation,affix corporate seal here: <br /> Title 18 U.S.0 1001,makes it a crime for any person knowingly or willfully to make to any department or agency of the United States any raise,fictitious or fraudulent <br /> statements or representations as to any manor within its jurisdiction,subject to a nne of up to SI0.000 and imprisoament up to 5 yoga <br /> NOTICES <br /> The Privacy Actor 1974 and the regulation in 43 CFR 2.48(d)provide that you be furnished the following information in connection with information <br /> required by this application. <br /> AUTHORITY:30 U.S.C.601 cl seq.;43 CFR 3600 <br /> PRINCIPAL PURPOSE:BLM uses this information to identify the parties entering into contracts for disposing of mineral materials. <br /> ROUTINE USES:BLM will transfer information from the record or the record itself to appropriate Federal,Stale,local,or foreign agencies,when <br /> relevant to criminal,civil,or regulatory investigations or prosecutions. <br /> EFFECT OF NOT PROVIDING INFORMATION:If you do not provide this information to BLM,%ve will not be able to process your application for a <br /> contract. <br /> The Paperwork Reduction Act of 1995 requires us to inform you that: <br /> The BLM is collecting this information to process your application and effea a binding contract. <br /> The BLM will use this information to identify and communicate with applicants. <br /> You must respond to this request to get a benefit. <br /> The BLM would like you to know that you ore not required to respond to,this or any other Federal agency-sponsored information collection which does <br /> not have a currently valid OMB control number. <br /> BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average about 30 minutes per response,Including the <br /> time for reviewing instructions,gathering and maintaining data,and completing and reviewing the form.Direct comments regarding the burden <br /> estimate or any other aspect of this form to U.S.Department of the interior,Bureau of Land Management(1004-0103),Bureau Information <br /> Collection Clearance Officer(WO-630).1849 C Street,N.W..Mail Slog 401 LS,Washington.D.C.20240. <br /> (Form 3600.9,page 3) <br />