certificate of inspection and possession - Bureau of Land Management

certificate of inspection and possession - Bureau of Land Management

Form 2000-5 (August 2005) Serial Number: UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT Reference: CERTIFICATE OF INSPECTION AN...

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Form 2000-5 (August 2005)

Serial Number: UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT

Reference:

CERTIFICATE OF INSPECTION AND POSSESSION (FOR ONE INSPECTOR)

This relates to an acquisition of the following described land, or an interest therein, by the United States of America. A. Property and project information: 1. The acquiring federal agency is: 2. The name and address of the owner(s) of the property is:

3. The property is identified and/or described as follows:

4. The estate(s) to be acquired is/are:

5. The condemnation proceeding name and civil action number are: N/A

B. Certification: I hereby certify that on , I made a personal examination and inspection of that certain tract or parcel of land identified above, and that I am fully informed as to the boundaries, lines and corners of said tract. I also spoke with the above-named owner(s) and with any other occupants (identified below) of said land. On the basis of my inspection and inquiry, I hereby certify that the following statements are accurate, or, if one or more statements is not accurate I have marked it/them and I have indicated on this sheet or on an attachment my findings which vary from the statement:

Signature

Print Name

Date

Address

Telephone Number (Continued on page 2)

1. No work or labor has been performed or any materials furnished in connection with the making of any repairs or improvements on said land within the past months that would entitle any person to a lien upon said premises for work or labor performed or materials furnished, 2. There are no persons or entities (corporations, partnerships, etc.) which have, or which may have, any rights of possession or other interest in said premises adverse to the rights of the above-named owner(s) or the United States of America. 3. There is no outstanding unrecorded deed, mortgage, lease, contract, or other instrument adversely affecting the title to said premises. 4. There are no vested or accrued water rights for mining, agricultural, manufacturing, or other purpose; nor any ditches or canals constructed by or being used thereon under authority of the United States, nor any exploration or operations whatever for the development of coal, oil, gas or other minerals on said lands; and there are no possessory rights now in existence owned or being actively exercised by any third party under any reservation contained in any patent or patents heretofore issued by the United States for said land. 5. There are no outstanding rights whatsoever in any person or entity (corporation, partnership, etc.) to the possession of said premises, nor any outstanding right, title, interest, lien, or estate, existing or being asserted in or to said premises except such as are disclosed and evidenced by the public records, as revealed by the government's title evidence. 6. Said premises are now wholly unoccupied and vacant except for the occupancy of the following, from whom disclaimer(s) of all right, title and interest in and to said premises, executed on has (have) been obtained:

(Form 2000-5, page 2)

Form 2000-6 (August 2005)

Serial Number: UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT

Reference:

CERTIFICATE OF INSPECTION AND POSSESSION (FOR TWO INSPECTORS)

This relates to an acquisition of the following described land, or an interest therein, by the United States of America. A. Property and project information: 1. The acquiring federal agency is: 2. The name and address of the owner(s) of the property is:

3. The property is identified and/or described as follows:

4. The estate(s) to be acquired is/are:

5. The condemnation proceeding name and civil action number are: N/A

B. Certification (physical inspection): I hereby certify that on , I made a personal examination and inspection of that certain tract or parcel of land identified above, and that I am fully informed as to the boundaries, lines and corners of said tract. On the basis of my inspection, I hereby certify that the following statements are accurate, or, if one or more statements is not accurate I have marked it/them and I have indicated on this sheet or on an attachment my findings which vary from the statement:

Signature

Print Name

Date

Address

Telephone Number (Continued on page 2)

1. No work or labor has been performed or any materials furnished in connection with the making of any repairs or improvements on said land within the past months that would entitle any person to a lien upon said premises for work or labor performed or materials furnished, 2. There are no persons or entities (corporations, partnerships, etc.) which have, or which may have, any rights of possession or other interest in said premises adverse to the rights of the above-named owner(s) or the United States of America. 3. There are no vested or accrued water rights for mining, agricultural, manufacturing, or other purpose; nor any ditches or canals constructed by or being used thereon under authority of the United States, nor any exploration or operations whatever for the development of coal, oil, gas or other minerals on said lands; and there are no possessory rights now in existence owned or being actively exercised by any third party under any reservation contained in any patent or patents heretofore issued by the United States for said land. 4. There are no outstanding rights whatsoever in any person or entity (corporation, partnership, etc.) to the possession of said premises, nor any outstanding right, title, interest, lien, or estate, existing or being asserted in or to said premises except such as are disclosed and evidenced by the public records, as revealed by the government's title evidence. 5. Said premises are now wholly unoccupied and vacant except for the occupancy of the following, from whom disclaimer(s) of all right, title and interest in and to said premises, executed on has (have) been obtained:

(Continued on page 3)

(Form 2000-6, Page 2)

C. Certification (owner inquiry): I hereby certify that on I spoke with the abovenamed owner(s) and with any other occupants (identified below) of said land. On the basis of my inquiry, I hereby certify that the following statements are accurate, or, if one or more statements is not accurate I have marked it/them and I have indicated on this sheet or on an attachment my findings which vary from the statement:

Signature

Print Name

Date

Address

Telephone Number

1. No work or labor has been performed or any materials furnished in connection with the making of any repairs or improvements on said land within the past months that would entitle any person to a lien upon said premises for work or labor performed or materials furnished, 2. There are no persons or entities (corporations, partnerships, etc.) which have, or which may have, any rights of possession or other interest in said premises adverse to the rights of the above-named owner(s) or the United States of America. 3. There is no outstanding unrecorded deed, mortgage, lease, contract, or other instrument adversely affecting the title to said premises. 4. There are no vested or accrued water rights for mining, agricultural, manufacturing, or other purpose; nor any ditches or canals constructed by or being used thereon under authority of the United States, nor any exploration or operations whatever for the development of coal, oil, gas or other minerals on said lands; and there are no possessory rights now in existence owned or being actively exercised by any third party under any reservation contained in any patent or patents heretofore issued by the United States for said land. 5. There are no outstanding rights whatsoever in any person or entity (corporation, partnership, etc.) to the possession of said premises, nor any outstanding right, title, interest, lien, or estate, existing or being asserted in or to said premises except such as are disclosed and evidenced by the public records, as revealed by the government's title evidence. 6. Said premises are now wholly unoccupied and vacant except for the occupancy of the following, from whom disclaimer(s) of all right, title and interest in and to said premises, executed on has (have) been obtained:

(Form 2000-6, Page 3)