Application for Use of Trust Lands

Date(Required)

Company or Individual Name(Required)

Contact Name (if a company)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

County(Required)

I (we) hereby make application, pursuant to Title 53C, as amended, and Trust Lands Administration rule, to lease the following described trust land situated in the above County.

Land Requested*(Required)

Township

Range

Section

Aliquot Parts

Acres

*Attach additional sheets if necessary.

TOTAL ACRES:(Required)

Information submitted as part of this application is generally publicly available pursuant to the Government Records Access and Management Act, Title 63G, Chapter 2 of the Utah Code. If you need to submit proprietary information, trade secrets, or commercial or non-individual financial information that you would like to remain confidential, please contact Trust Lands Administration for details on how to submit such information under confidentiality.

Applicant's Signature(Required)

TITLE

Note: A non-refundable application fee of $250.00, advertising fees, and other deposits will be due upon the agency's acceptance of this application.

Application for Use of Trust Lands

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