Form 813 - Application For Hunting/fishing Permit - Milan Army Ammunition Plant
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1
2Application for Hunting/Fishing Permit (MLAAPR 420-2)
(Section A – Privacy Information
)
1.
Authority: Privacy Act of 1974, as amended, 5 U.S.C. Section 552a
2.
Principal Purposes: Obtain pertinent information upon which to authorize issue of installation seasonal
hunting/fishing permit. All applicants must possess State of Tennessee Hunting/Fishing License and
Hunter Safety Certification before MLAAP permit can be issued. Will be protected from unauthorized
access or use. Information within this form will be destroyed when no longer needed.
3.
Routine Uses: To assure the applicants are eligible to hunt/fish on MLAAP.
(Section B – Application)
1.
Request a season permit be issued to hunt and fish on the Milan Army Ammunition Plant. I hereby
agree to abide by MLAAPR 420-2, Hunting, Fishing and Trapping Regulations, and applicable
provisions of Federal and State Game and Fish Laws. Any violation or infraction thereof may result in
the revocation of this permit and subject me to such disciplinary action as may be appropriate.
_____________________
________________
________________________
_________________
Name
Hunter Category *
Home Address
Work Phone No.
_____________________
________________
______________________
_________________
Hunter Safety Date
Orientation Date
TBI or Carry Permit Date
Home or cell No.
*
Category: employee, retired employee, RIF employee, public, special exception, active
military, retired military, disabled veteran (Color copy of military I.D. card required)
Sportsman Hunt License No. _____________ State Hunt License No._______________
2.
Migratory Waterfowl License No
____________________Federal Stamp ____________
3.
.
4. Lifetime License No. ______________________
5. Big Game Archery License No. _________________
NOTE: Copies of all licenses
6. Big Game Muzzleloader License No. ________________
required for verification
7. Big Game Gun License No. ___________________
Check or M.O. payable to U.S. Treasury accompanies this application. CASH NOT
8.
ACCEPTED. (NOTE: $5.00 processing fee only for changes made to original permit)
(Mark applicable box that applies)
Fishing ($15.00 per individual, season & See exceptions below*)…..………. __________
Small Game ($15.00 per individual, all seasons)…..……………….……………
__________
Migratory Waterfowl ($15.00 per individual, season)……………………………..
__________
Turkey ($25.00 per individual, all seasons)…………………………………….….
__________
Deer – Archery ($25.00 per individual, all seasons) ……………………………...
__________
Deer – Muzzleloader ($25.00 per individual, all seasons) ……………………...
__________
Deer – Gun ($25.00 per individual, all seasons) ………………………………….
__________
Sportsman - ($80.00 per individual, includes all hunting & fishing) ..…….…..…
__________
Senior Sportsman – ($10.00 per individual (65 yrs & older; all hunting & fishing) __________
* Fishing Exceptions: (children - no fee under 12 yrs; 12 – 18 yrs = 10.00)
9.
Request each legal dependent, including age, license number, and hunter safety course
issue date listed on the back of this application be included on my permit to hunt.
10. I have read and agree to the Waiver and Release of Tort Claims and Indemnity Agreements
contained on the reverse of this form.
11. _________________________________
__________________
______________________
Signature of Applicant
Date
DOB: Date of Birth
Will read MLAAP Regulations on website
Need copy of MLAAP Regulations w/permit
(Section C – Assignment
)
Permit No. _____________
Date: ______________
Issued By ____________________
Approved By __________________
Form 813
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