Form 4110-5
(July 2008)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
Processing Worksheet: Lien Holder Notice of Interest
in Base Property and/or BLM Grazing Authorization
Purpose: Use to determine if a submitted lien holder notice of interest in base property and/or a BLM
grazing permit or lease is sufficient and appropriate to meet the BLM’s regulatory needs.
Instructions: Examine the lien holder notice. The worksheet should then be completed as follows:
1. Questions 1 through 7: If any answer is “NO,” return the notice to the lender, unprocessed, and inform
the lender of the information that should be included in the notice.
2. Question 8: If the answer is “NO,” return the notice to the lender, unprocessed, and inform the lender of
the information that should not be included in the notice.
3. If questions 1 through 8 are answered “YES,” provide to the lender acknowledgement of receipt of the
notice (if requested) and then file a copy of the acknowledgement with the notice in the case records of the
subject operator and record in the Rangeland Administration System (RAS).
This worksheet may be destroyed after use and should not be retained in the operator case record.
Item
No.
Lien Holder Notice Information Requirements
Yes
No
1
Does the borrower identified by the notice hold a grazing permit/lease issued by
the BLM?
2
Does the BLM office that received the notice administer the borrower’s grazing
permit/lease?
3
Does the notice identify the lender and the lender’s contact information?
4
Does the identity of the borrower listed in the notice match the identity of the
entity that owns the base property that is on record with BLM and to whom the
BLM permit/lease was issued? (Check base property deed or other “evidence of ownership”
documents in BLM’s case records. For example, the identity of borrower “John Doe” does not match “J. Doe”
or “John and Jane Doe” or “John Doe Ranch” or “John Doe, Inc.” or “Doe Ranch LLC” or “John Doe dba Doe
Ranch,” etc.)
5
If the notice indicates that the permittee/lessee granted the lender a security
interest in real property of the permittee/lessee, does the notice include a legal
description of that property that matches or includes the base property
description listed in the permittee/lessee case records?
6
If the notice indicates that the permittee/lessee has pledged its grazing
permit/lease as security for the loan, does the notice clearly identify the specific
BLM grazing permit/lease that has been pledged?
7
Does the notice identify the loan number, the date the loan was issued, and the
projected date that the loan will be repaid in full?
8
Does the notice exclude the loan amount?
