2011 Owyhee River below the Dam
Post-Use Report Form
U.S. Department of the Interior, Bureau of Land Management
Vale District, Jordan Field Office,100 Oregon St., Vale, OR 97918-9630
541-473-3144 or fax 541-473-6213
For Administrative Use Only:
SRP#: ORV030-SR11____-____
Fill in all the requested information below. Attach additional sheets if necessary. If no use was conducted during the year,
make note in the table below.
Business Name: _____________________________________________________________________
Permittee Name: ____________________________________________________________________
Address: ________________________________ City: _________________State: _____Zip: _______
Phone Number: ____________________________ E-mail: __________________________________
Signature of Permittee: _______________________________________________________________
Do not send remittance until you receive a bill from USDOI-BLM
Date
Total Number of
Guides
Clients
Amount per
Client
Adjusted Charge per
Total Trip Revenue
Client*
Total Amount:
*Deductions for Transportation and Lodging - are allowable only before customers arrive at the permittees headquarters or local
community or at the end of the trip after they leave the headquarters or local community (example - If an outfitter was based in Boise,
Idaho or using a commercial facility there as a base operation, he/she could deduct transportation and lodging charged to the
passengers while en route to Boise.)
These deductions are not allowed for costs incurred between the permittee's headquarters or local community and the public lands, or
for costs incurred during the permitted activity or trip regardless of public or private land status.
To arrive at the adjusted charge, deduct off-river transportation and/or lodging expenses (explain below):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
For Administrative Use Only:
Total Gross Revenue: $_____________ x 3%= $_____________ -$95 Application Fee = Amount Owed $_____________