BUREAU OF LAND MANAGEMENT
                 GENERAL LAND OFFICE AUTOMATED RECORDS SYSTEM
                         DOCUMENT IMAGE ORDERING FORM


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Please supply the following information for each image you want a copy of:

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State: _____________________  Accession Number: ________________________

Patentee Last Name: ____________________________________________________       
 

Patentee First Name: _____________________________  Middle Initial: ____

Number of copies of the document requested: __________

Certification requested (Yes/No): _______

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State: _____________________  Accession Number: ________________________

Patentee Last Name: ____________________________________________________       
 

Patentee First Name: _____________________________  Middle Initial: ____

Number of copies of the document requested: __________

Certification requested (Yes/No): _______

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Send requests to:   Bureau of Land Management 
                    Eastern States
                    7450 Boston Boulevard
                    Springfield VA 22153-3121  
                    
                    Attn:  GLO Records Access Section 
                             
                             OR
                    
                    Fax (703) 440-1609

                    E-mail: records@es.blm.gov


Copy Fees:  The first copy of each patent ordered from the Accession Number 
            supplied from this CD-ROM will cost $1.25 for a single-page 
            document.  Additional copies of the same patent may be obtained 
            for $0.13 per page.  The certification fee is $0.25 per copy of 
            the patent if requested.  

Please Note:  A patent listing four (4) land descriptions will occur as four 
              (4) records in the CD-ROM database.  However, all four (4) 
              records will have the same Accession Number and refer to the 
              same patent.  To obtain a single copy of the patent, list the 
              Accession Number only once on the order form.