RECREATIONAL VEHICLE AND STORAGE REGISTRATION
Name: (last, first)_________________________________Pay Grade:______________
Address: ____________________________________________City:______________
State: ______Zip: __________Duty
Phone Number: ( )______________________
SSN: ____________________Home
Phone Number: ( )______________________
Vehicle Description:
______________/_______________/__________/_____________
RV type
make
year
length
License Number:_________________State:_____________Exp. Date:______________
Vehicle ID Number __________________________
Email Address (optional)
________________________
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C.,
Section 301, AR 25-55, AR
340-17. PRINCIPAL PURPOSE(S): To register eligible
personnel prior to obtaining a parking permit for Recreational Vehicle
Storage Area. ROUTINE USES: General
maintenance of current information on individuals storing campers, trailers
or recreational vehicles in the storage areas. Requested information is necessary in the event of an emergency,
the owner can be contacted for corrective action. MANDATORY OR VOLUNTARY
DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary
disclosure. The registration
of a recreational vehicle cannot be completed without this information.
I UNDERSTAND AND AGREE THAT:
1. In consideration (or in exchange) for being permitted to utilize the Fort Belvoir Outdoor Recreation Vehicle (RV) lot, I hereby release the Fort Belvoir Morale, Welfare and Recreation and the United States Government from any liabilities or claims which result from theft or vandalism during my use of the RV storage facility. I also agree that I will never prosecute or in any way aid in prosecuting any demand, claim or suit against the Morale, Welfare and Recreation or the United States Government for any loss or damage to my property that may occur as a result of theft or vandalism during my use of the provided lot for RV storage.
2.
There is a risk of theft or vandalism in this area and
that I will need to maintain appropriate insurance coverage on my RV
(and its contents) in order to protect myself against such risk. Otherwise, I will self-insure and assume
the risks involved.
3.
I must maintain valid and current state registration on
my RV.
4.
I may be held liable for any damage or loss to the Morale,
Welfare and Recreation or the United States Government that is caused
by my negligence, willful misconduct or fraud.
5.
My property will be considered abandoned 30 days past
due date in accordance with Virginia State Code Section 46.2-1208 and
DoD 4160.21-M “Defense Material Disposition Manuel”, Chapter
4, Paragraph 40 if timely payment is not made. At that time, MWR will impound vehicle and execute plans to
sell at public auction or otherwise dispose of the property.
__________________________
_____________________ OWNER’S SIGNATURE DATE
OFFICE USE ONLY
Payment Record: Credit Card Check Cash Payment Type: Annual Monthly: _______________
FB FORM 13A Aug 01 |