Land And Water U.S.A.

Tuesday, April 14, 2020



Please consider this signed agreement as permission granted to:
Address: __________________________________________________
Phone #_________________________________________________
To be admitted on the property of: __________________________________________Grantor
And to be confined to: _____________________________________________

Please check one of the following:  Private citizen_____Public Servant_____
If Private Citizen: Organization Affiliation ___________________________
(In addition to this agreement, Public Servant will be required to fill Public Servant’s Questionnaire pursuant to the Privacy Act of 1974, and attach to Grantor’s PPAA.)
1) Grantee accepts full responsibility for his/her actions while on said property, and thereby waives Grantor of any liability whatsoever.
2) Grantee agrees that he or she is a guest on Grantor’s private (includes allotment owner) property accepts burden of performance, and acknowledges any action not agreeable to (3).  
3) Authorizes Grantor opportunity to terminate agreement at any time .
4) Grantee does not have permission to share any activity (includes hunting, fishing, dirt moving) or material (includes land, water, structure, fauna, flora, photography, electronic image or video) they see, with any government, government agent, government contractor, representative, private entity, non-profit agent, non-government public organization or non-profit private organization.
5) Grantee must be aware and hold Grantor harmless of, certain hazards, both man-made and natural. These hazards may include, but are not limited to barbed and hot wires, sinkholes, water (river/creek etc.), livestock, domestic and wild animals, machinery etc. 
6) Grantee promises to: Notify Grantor prior to each time Grantee desires to enter property; exercise full consideration of this privilege granted; will be absolutely observant of keeping shut gates shut, not leave behind any material Grantee brings in; not remove any material from Grantor’s property; not intentionally bring damage to any part of the land, water, farm animals or livestock, and not move beyond area defined in agreement.
7) Grantee acknowledges they will not disturb any animals, living trees, shrubs, buildings, well sites, electrical sites etc. 
8) This agreement is non-transferable, and on a one-person only basis.
9) Grantee does not have authority to enter any building on property. 
10) Grantee must have agreement available to show Grantor or any person Grantor authorizes to request show of said agreement; if Grantee fails to show requested agreement, Grantor or Grantor’s authorized person will hold right to terminate this agreement and demand Grantee leave of property immediately.

Agreement start date:__________Agreement termination date:_______________
Signed (Grantee) ________________________________________________________________

Signed (Grantor) _________________________________________________________________


Public Servant Questionnaire
This questionnaire must be filled-out by any public servant before he can ask the citizen any question.  This is authorized by federal law, including the Privacy Act, 5 U.S.C. 552a, 88 Stat. 1896, et seq., 1974.
1.     Public servant's full legal name:
2.     Public servant's residence address:
3.   Name of agency:
4.   Name of supervisor and office address:
5.   Will public servant uphold the constitution of the United States?
      Yes  No
6.   Did public servant provide proof of identity?
       Yes  No
7.   ID number:
     Badge Number:
     Bonding agency and number:
8.   Will public servant furnish a copy of the law or regulation that authorizes the action being taken or information requested in this case?
      Yes  No
9.   Will public servant read aloud that portion of the law authorizing the questions asked?
      Yes  No
10.  Are answers voluntary or mandatory?
      Voluntary  Mandatory
11.  Are the questions being asked based upon a specific law or regulation, or are they a discovery process?
12.  What other uses may be made of this information?
13.  What other agencies may have access to this information?
14.  What will be the effect upon me if I should not choose to answer any or all of these questions?
15.  Name of person in government requesting this information:
16.  Is this investigation general or special?
Note: by ‘general,’ it means any kind of blanket investigations in which a number of persons are involved because of geography, type of business income, etc. By ‘special,’ it means any investigation of an individual nature in which others are not involved.
17.  Have you consulted, questioned, interviewed, or received information from any third party relating to this matter?
      Yes  No
18.  If yes, give identity of all such third parties:
19.  Do you reasonably anticipate either a civil or criminal action to be initiated or pursued based upon any of the information which you seek?
      Yes  No
20.  Is there a file of records, information, or correspondence relating to me being maintained by this agency?
      Yes  No
21.  Is this agency using any information on me which was supplied by another agency or government source?
      Yes  No
22.  Will the public servant guarantee that the information in these files will not be used by any other department other than the one by which he is employed?
     Yes  No

            I hereby sign and affirm under the penalty of perjury that the answers are true and correct in every particular.
            Signature of public servant
Notice: If any request for information relating to me is received by any person or agency, you must advise me in writing before releasing such information.  Failure to do so may subject you to possible civil or criminal action as provided by this act or other law(s).

Official printable questionnaire:



Attention: ______________________________________

From: __________________________________________

I, the undersigned, am a Private Property Owner (Hereafter referred as Owner) whose properties may include deeded land, grazing allotments, certain permits, trademarks and agreements, animals, water shares, rights of way, easements, cattle trailways, gas oil and mineral rights, water/forage and other beneficial uses deemed legal, titled structures, airspace and business (Hereafter referred as Properties) located in the county(s) of _________________ in the state of _______________________________
It has been brought to my attention that through voiced intentions, public media, videos, maps, photos, prospectus, FOIA and other certain papers (Hereafter referred as Reports), ________________________________________   ____________________potentially in conjunction with nonprofit and for-profit affiliate organizations, and/or representatives (Hereafter referred collectively as Entity), has allegedly assumed and or is speculating use(s) for Properties, and other properties not owned by Owner but are nearby and or conjoining Properties to the extent use of could jeopardize Owner’s Properties.
Because Entity did not seek written consent or permission from Owner for admittance on and or any use whatsoever of Properties, Owner considers Entity may have arbitrarily engaged in unlawful trespass.
Entity’s alleged Reports have already harmed Owner by creating a nuisance that is needlessly- possibly intentionally - disturbing, violating, and encumbering rightful usage, creating a financial burden, and placing a cloud on Properties.
As Owner whose Properties, income and business are now negatively impacted by Entity’s alleged Reports, I am providing this Demand to Remove Property References to serve as my formal demand: Entity must remove, erase and delete any and all references of Properties from any and all materials generated by, or utilized by Entity, potential affiliates or representatives (contracted or volunteered), within thirty (30) business days of receipt of this letter (Sent certified with return receipt.).
In keeping with my State and Federal Constitutional rights to acquire, possess and protect my Properties, I, the undersigned as Owner, hereby demand Entity file a certified letter with the clerk and assessor in each before-mentioned County(s), clearly affirming that Entity has removed any and all references of Properties from any and all Reports Entity and his or her allied organizations have, within thirty (30) business days of receipt of this letter.
Should Entity choose not to comply with Owner’s Demand to Remove Property References, Owner will exercise the right to remedy (includes liens and seizures), as may be appropriate and provided by law.
Should Entity’s non-compliance result in Owner having to take action to remove Properties and Owner referencing from Entity’s Reports - starting at the expiration of thirty (30) business day period, Owner will exercise the right to remedy as may be appropriate and provided by law. 
In this particular matter, Owner is not associated in any manner whatsoever with Entity or representatives, affiliates, and or family members of Entity. Owner has no knowledge of Entity’s specific plans or intentions. Therefore, Owner is to be held harmless and totally exempt from any liabilities whatsoever that may result, or have resulted from any representation whatsoever Entity (representatives, affiliates and or family members of Entity) may have made to any persons as pertains to Owner or Properties.
Signed _______________________________________________________
Date __________________________
Cc: Governor, County Commissioners, County Sheriff, Interested Parties

Notary Seal


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