Get Self-certification Statement From Lessee/operator Surface ... - Blm

This guide will assist you in properly completing the Self-Certification Statement from Lessee/Operator Surface for the Bureau of Land Management. By following these steps, you can ensure that your submission is accurate and meets all necessary requirements.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in your document handling system.
2. Begin by entering the Federal or Indian Lease Number. This identifier is essential for tracking your application.
3. In the certification section, select one of the agreements you have reached with the Surface Owner by marking the appropriate box. Choose from the following options: 1) signed access agreement, 2) signed waiver, 3) agreement on compensation for damages, or 4) a statement of failure to reach an agreement and a plan to obtain a bond.
4. If unable to reach an agreement with the Surface Owner, provide additional confirmation by indicating your intent to comply with state compensation requirements relevant to non-Federal surface and mineral estate.
5. Fill in the Surface Owner information if available. Include the Surface Owner's name, address, and phone number to assist with any follow-up communications.
6. Finally, sign and date the document at the specified location. Ensure your name is printed clearly beneath the signature.
7. Once all fields are completed, review the form for accuracy. Then, save your changes, download a copy, print the document, or share it as needed.

Complete your Self-Certification Statement online today to ensure compliance and efficiency in your submissions.