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v ~\ \; . <br />~ __ <br />~; ' <br /> <br /> ~• , j <br />_... <br />NOTICE <br />The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) providt that you be furnished the following <br />information in connection with information regmrcd by this application. <br />AUTHORITY: 30 U.S.C. 601,602; 43 U.S.C. 1201; 60 Stat. 367 <br />PRINCIPAL PURPOSE -The information is to be uscd to process your application for a Free Use Permit. <br />ROUTINE USES: <br />(I) The adjudication o(the applicants rights to the land or resources. <br />(21 Documentation for public information in support of notations made on land status records for the <br />management, disposal, and use of public lands and resources. , <br />13) Translcr to appropriate Federal agencies when concurrence is requucd prior to granting a right in <br />public lands or resources. <br />(4) Transfer to the U.S. Departmem of Justice in the event of litigationimolvingthe records or the subject <br />matter o(the records. ' <br />IS) Transfer, in the event there is indicated a violation or potential violation of a statute, regulation, rule, <br />.~ order orlicense, whahercivil, criminal or regulatory in nature,to the appropriate agency or agencies, ~ ' <br />whet her Federal, State, local or foreign, charged with the responsibility of invest igation or prosecuting <br />such violation or charged with enforcing orimplementingthe statute, rule, regulation, order orlicense <br />' violated or potentially violated. <br />i <br />EFFECT OF NOT PROVIDING INFORMATION - Ifyou do not furnish all the mfnrmation reywred by this <br />form, your application may be rejected. , <br />' The Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et. segJ requires us to inform you that: ' <br />i Information is being collected to obtain vegaal and mineral depletion information relevam to natural <br />resource inventory. <br />' Information will be uscd for deplnion records. I <br />Response to this request is mandatory (43-5510) to fulfill the requirements for the cooing of umber and for <br />oil and gas claimants. , <br />