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Sec. '18- EJiecrire date. This contract bzconlzs zffatti~e as indicu2d bzlot~. <br />_I If this contract becomes effective on the date BL~I signs the contract, BL~I will check this box. <br />lJ If this contract becomes effective only after certain conditions are met, BLdI will check this box, list [he 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 undzr Parts 4 and 1840 of Title 43 of thz Code <br />of Fedzral Reeularions. <br />The following parties have executed this contract as of: <br />PURCHASER THE UNITED STATES OF AMERICA <br />~l6ra ~ ~ ©1~.~~es B~ -- <br />(Individual or Firm Name) <br />(Address) (Aut ri~er~. <br /> <br />~i _~~_I~l__1bt~ln~?(_ <br />{Tide) <br />(Date) <br />tmgnumrc~ <br />If } uu ore a corporation, affix corporate szal hire: <br />Title 18 U.S.C. Section 1001, makes i[ a crimz for an} pzrson knowingly or willfully to makz to any dzpartment or agency of the Unitzd <br />States am false, [ictiuous or fraudulent statements or represzntazions as to any maazr within its jurisdiction. subject w a tine of up to <br />510.000 and imprisonment up to 5 years. <br />Fhe Papzn~urk Reduction Act of 1991 la-I U.S.C. 3501 e( seq.; <br />requires us to inform you that: <br />BL:x( is collzctin_ this information to process ?'our application <br />and eFfzc[ a bindine contract. <br />BL~f sill use this information [o idzntitb and communicate tsith <br />appiian[i. <br />ti w must rzspund w this request w ezt a bznetit. <br />ROUTI\E USES: .. ~,ti!; transfer inormati~.,r~ t=..m 1he rcccrd <br />or thz record itself to appropria[z Federate smte, local. or forei_n <br />a~encias. ohen rclesam [o criminal cisll. or ro~ulmon <br />in.esti~ations or proszcu[ions. <br />F.F'FEC-I 0 A'OT PROA'IDIAG IXFOR?IATIOX: If you do not <br />pru~ldc this lnfm'm utiun to BLAI. tic will not h: able to pr.~c_» <br />~ our uppli..aion for ¢ cun[e:et. <br />A federal a~zncy ma? not conduct or sponsor, and you acct not ~ BLV zstim'tas the public raportin~ burden fur thi; for;n at ;m <br />require) to raspond w, an information collection :+hich dots no[ at zrage of 30 mimt[as pzr rasporoz, inrludine thz time for <br />have a currend? valid O~~IB control number. i m izuinu instructions. ~a[herin~ and maintainine data. and <br />Vf'T UORI fY~ ;O l'. S.C. 601 et yet -: ~13 CFR 3600 completin_ and rz~ieu in. the Form. Dirzc[ comments ruaardin_ <br />- - ~ the burd:;n rsnmu:e or am other a,pcct of thi, form m l~.i <br />PRRCiP.-~L PURP03E; BL:xf uses this in[ormation to identi!} ~ Uepartmern of the Interior. Bureau of Land ~lanaeemznt. &:roau <br />the parties en[erins into contracts for di>posing of mineral I Information Collection Clzarnnee Officer. 0 00-1-0 1 03 1_ IS-l9 C <br />materials. ~ S[.. A.li~-. ll: it Stop 10I LS. U~ashingW n. D.C. 30?~FU <br />EXHIBIT N <br />