Form 813 - Application For Hunting/fishing Permit - Milan Army Ammunition Plant (Page 2 of 2) in pdf

Application for Hunting/Fishing Permit (MLAAPR 420-2)

Eligible Dependents: Spouse and children 22 years of age or younger

(Mark applicable box and attach copies of all licenses)

Spouse

Child

Name

____________

DOB: (for hunters)

____________

Orientation Date

____________

Hunter Safety Date

____________

TBI or Carry Permit Date

(hunters 18 & older) ____________

____________

Sportsman Lic. #

____________

State License #

____________

Deer (Bow) Lic #

___________

____________

___________

Deer (Muzzle) Lic #

___________

____________

___________

Deer (Gun) Lic #

___________

____________

___________

Turkey

___________

____________

___________

Small Game

___________

____________

___________

Waterfowl

___________

____________

___________

Fish

___________

____________

___________

Waiver and Release of Tort Claims and Indemnity Agreements

Upon entering the Milan Army Ammunition Plant for the purpose of hunting and/or fishing. I waive any

and all claims and release American Ordnance LLC and the Government of the United States, its

agents and employees, from any liability for injury or death of any person, including myself, and for

damage to property, occurring on the said premises and hereby agree to indemnify and save harmless

American Ordnance LLC and the United States Government from any such liability. This release &

indemnity & hold harmless agreement is binding on my heirs, assignees, executors, administrators, &

legal representation.

I have read and understand MLAAP’s Environmental Policy. I assume all environmental responsibility

for myself, my dependents, and any guests that I may bring. ________ (Hunter initials)

I consent to my minor dependent’s participation in hunting and fishing activities and will abide by the

above indemnity agreement. ________ (Hunter initials)

In addition, I agree to be responsible for and to pay American Ordnance LLC and/or the Government for

any damage done to Government property.

Signing of this statement does not waive any rights or benefits I may be entitled to as a member of the

Armed Forces of the United States Government

"I understand that if I am allowed to take "guests" into storage areas that I assume full responsibility for

their actions & will be assigned same penalty for any violations incurred by my guests." _____ (hunter

initials).

Auto Liability Insurance

Yes

________(Hunter initials)

Driver’s License No.

__________________ (copy required)

(For Accounting Purposes Only)

Check No.

Check Amount

Date Received

Issued By

__________

____________

_____________

___________

__________

____________

_____________

___________

Form 813

Page 2 of 2

Form 813 - Application For Hunting/fishing Permit - Milan Army Ammunition Plant Page 2

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