"Assignment Liability Form"

Assignment Liability Form is a 1-page legal document that was released by the U.S. Department of the Interior - Indian Affairs, Osage Agency and used nation-wide.

Form Details:

  • The latest edition currently provided by the U.S. Department of the Interior - Indian Affairs, Osage Agency;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more legal forms and templates provided by the issuing department.

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OMB# 1076-0180
Expires 1/31/2020
Reference ID
(Internal Use Only):
Legal Description:
BIA Lease Number:
Compliance Due Date:
Assignment Liability Form
Lessee Contact Information
:
Assignee:
Phone Number:
Address:
City:
State:
Zip:
Non-Compliance Issue(s)
:
The following work shall be completed by
:
See letter for other pertinent information regarding instructions, extensions & regulations.
I/We assume the responsibility of the above corrective actions related to the above described
lease.
Name (Printed)
Signature
Date
OMB# 1076-0180
Expires 1/31/2020
Reference ID
(Internal Use Only):
Legal Description:
BIA Lease Number:
Compliance Due Date:
Assignment Liability Form
Lessee Contact Information
:
Assignee:
Phone Number:
Address:
City:
State:
Zip:
Non-Compliance Issue(s)
:
The following work shall be completed by
:
See letter for other pertinent information regarding instructions, extensions & regulations.
I/We assume the responsibility of the above corrective actions related to the above described
lease.
Name (Printed)
Signature
Date