Government Exhibit 5
USDA - Forest Service
SPECIAL USE APPLICATION FOR NONCOMMERCIAL GROUP USES
(Ref.: 36 CFR 251.54)
18 U.S.C. 1001 makes it a crime for any person knowingly and willfully to make to any departmenmt or aagency of the United States any false, ficticious, or frauduent statements or representations as to any matter within its jurisdiction.
PART I - APPLICANT INFORMATION
(Please include zip code and day and evening phone numbers with area code.)
Name of Group: Rainbow Family
Name of Contact: Bill Baxter
Day Phone: (Blank)
Evening Phone: (Blank)
Address of Group or Contact (whichever is applicable):
Bill Baxter, West Virginia
Josef Greenfeather, CA
PART II - DESCRIPTION OF PROPOSED ACTIVITY
Mid Atlantic/ New England Regional Peace Gathering
PART III - LOCATION AND DESCRIPTION OF NATIONAL FOREST SYSTEM LAND AND FACILITIES APPLICANT WOULD LIKE TO USE
Warrants 3134, 3064, 3014, 3017 Cherry Grove Township.
Wooded Forest Land and open meadows
Area to be used for camping and common areas and parking.
PART IV - ESTIMATED NUMBER OF PARTICIPANTS AND SPECTATORS FOR PROPOSED ACTIVITY
Participants: 500-2500 Spectators: ________
PART V - STARTING AND ENDING DATE AND TIME OF PROPOSED ACTIVITY
Start: 08/21/96 End: 09/ /96
PART VI - NAME OF PERSON (S) WHO WILL SIGN A SPECIAL USE AUTHORIZATION ON BEHALF OF GROUP (May be same as contact listed in Part I)
Name: ______________________________ Address: ______________________________________
Day Phone: ( )____________ ______________________________________
Evening Phone: ( )____________ ______________________________________
Name: ______________________________ Address: ______________________________________
Day Phone: ( )____________ ______________________________________
Evening Phone: ( )____________ ______________________________________
APPLICATION NOT VALID UNLESS SIGNED BY CONTACT
Signature of Contact (Date)
(unsigned)
__________________________________________________________________________________________
FOREST SERVICE USE ONLY
__________________________________________________________________________________________
Authorization Granted___ Denied ___ Date: ___Time:____
Public reporting burden for this collection of information is estimated to average 15 minutes per response. including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden. to Department of Agriculture, Clearance Officer. OIRM, Room 404-w, Washington, D.C. 20250; and to the Office of Management and Budget, Paperwork Reduction Project (OMB #0596-0082), Washington, D.C. 20503. :
PART III - REPORT ON APPLICATION (Forest Officer Completes) (BLANK)
a. Name of Holder b. Date Authorized c. Date Closed
b. Has an Environmental Assessment been prepared? Yes No
c. Has an Environmental Impact Statement (P.L 91-190, 42 USC 4321)been prepared? Yes No
(Note: If no is maarked with an X in any of the above questions, explain in item 6 below.)
a. Approval* or Disapproval* b. Signature (Sign in ink) c. Title d. Date
10.Final Approval* or Disapproval* b. Signature c. Title d. Date
*Delete one by lining it out. U.S. Government Printing Office 1996
10a. Describe other reasonable alternative proposals considered.
10b. Give explanation of why it is necessary to utilize Federal lands and why the alternatives in item 10a were not selected.
I HEREBY CERTIFY, that I am of legal age and authorized to do business in the State and that I have personally examined the information contained in the application and that this information is correct to the best of my knowledge.
16a. Applicant's Signature (Sign in Ink)
16b. Date
Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly aand willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.