Laserfiche WebLink
TI c Paperwork Reduction Act of 1995 (44 U.S.C. 3501, et seq.) requires us to inform you that: <br />This information is being collected to authorize and evaluate proposed exploration and mining operations on public lands. <br />Response to the provisions of this lease form is mandatory for the types of activities specified. <br />BLM would like you [o know [ha[ you do no[ have to respond to this or any other Federal agency-sponsored information collection unless it <br />displays a currently valid OMB convol number. <br />BURDEN HOURS STATEMENT <br />Public reporting burden for this forth is one hour. This Includes reading [he instructions and provisions, completing and signing the ]ease <br />form to BLM. Dirac[ comments regarding [he burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau <br />of Land Management, Information Clearance Officer (WO-b30), Mail Stop 401 LS, Washington, D.C. 20240, and the Office of <br />Management and Budget, Office of Information and Regulatory Affairs, Interior Desk Officer (]004-0073), Washington, D.C. 20503. <br />THE UNITED STATES OF AMERICA <br />Company or Lesaee Name sC~ <br />r- .~ <br />(Signature of Lessee) <br />(Title) <br /> <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 ottee United States any <br />false, fictitious or fraudulent atatementa or representations as to any matter within its jurisdiction. <br />+U.S. GOVERNMENT PRINTING OFFICE: t999d49-SUS <br />® Pe1YI! a ddb Frye <br />F-J <br />i ~~_ <br />(J <br />~.') <br />C l <br />". i <br />J , <br />.l <br />v <br />ate) <br />