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p <br /> Sec. 15,SPECIAL STIPULATIONS(Cont'd)- <br /> r• " <br /> 2020 JU11 -2 A 10: 40 <br /> THE UNITED STATES OF AMERICA <br /> 'rn N _ -_kin _ gof G 13y <br /> pony or cc Name) <br /> r <br /> (Sigualurc oflessee) - (BLM) <br /> ice <br /> (Title) (Title) <br /> 0j <br /> (Date) <br /> (Date) <br /> Title 18 U.S.C.Section 1001,makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, <br /> fictitious or fraudulent statements or representations as to any matter within its Jurisdiction. <br /> (Continued on page 4) (Form 3400-12,page 3) <br />