Nps Form 10 931 – Fill Out and Use This PDF

Application for Commercial Filming/Still Photography Permit

Please supply the information requested below. Attach additional sheets, if necessary, to provide required information. Allow AT LEAST four (4) business days for processing. A non-

refundable processing fee should accompany this application unless the requested use is an exercise of a First Amendment right. You will be notified of the disposition of the application and the necessary steps to secure your final permit. Your permit may require the payment of cost recovery charges, a location fee, and proof of liability naming United States of America as also insured.

Applicant:	Company:
Social Security #:	Tax ID #:
Street/Address:	Street/Address:
City/State/Zip Code:	City/State/Zip Code:
Telephone #:	Telephone #:
Cell phone #:	Cell phone #:
Fax #:	Fax #:
Email:	Email:
Project name:	Producer:
Type of project:	Photographer:
Location manager:	Director:
Telephone #:	Caterer:
Cell phone #:	Telephone # - set:

Summary of Activities and Scene(s) (attach additional pages if necessary):

________________________

SCHEDULE BY LOCATION(S) (Includes filming, parking and base camp):

Date	Location	Start	End	Type of Activity	Number of
		Time	Time	(e.g., film, prep, or	Cast & Crew
				strike)

Description of Equipment/Props(attach additional pages if necessary):

______________________________________________________________________________

______

______________________________________________________________________________

______

______________________________________________________________________________

______

List of vehicles including type and license plate number (attach additional pages if necessary):

Vehicle Make and Model	License Number

Use of Roads and/or Trails? (Y/N):	Describe proposed use (attach additional pages if
necessary):

______________________________________________________________________________

______

______________________________________________________________________________

I hereby state that the above information given is complete and correct and that no false or misleading information or false statements have been given. All estimates are reliable to the best of my knowledge and I have the full authority to represent the applicant entity and the project described above.

Signature: __________________________ Print Name: ______________________ Date:

___________

Title: ______________________________ Company Name:

__________________________________

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Information provided will be used to determine whether a permit will be issued. Completed

application must be accompanied by an application fee in the form of a cashiers check or money order in the amount of $___.00 made payable to National Park Service. Credit card payments

may be accepted at some parks. Application and administrative charges are non-refundable. This