Fillable Personal Drone Use Flight Permission Form Fillable 1 (Utah DRE)

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Personal Drone Use Flight Permission Form Fillable 1 (Utah DRE)

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Utah Division of Real Estate (DRE) aims to protect the public and promote responsible business practices through education, licensure, and regulation of real estate, mortgage, and appraisal professionals

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PERSONAL USE DRONE FLIGHT PERMISSION FORM
VALID ONLY IF COMPLETELY FILLED OUT AND SIGNED. PERMIT MUST BE IN OPERATOR’S POSSESSION WHILE DRONE IS IN USE.
GENERAL INFORMATION
_______________________________ State Park grants the undersigned permission to operate a Federal Aviation Administration
(FFA) registered Small Unmanned Aircraft System (UAS) within the park’s boundaries. This form authorizes personal use only.
Any commercial use is strictly prohibited without Special Use Permit (SUP).
REQUESTOR INFORMATION
1. Name
4. Drone Make and Model
2. Phone Number
5. Remote Pilot Certificate Number
3. Address
6. Unmanned Aircraft Systems (UAS)
Street Address
UAS Certificate Number
City State Zip
Date Issued Expiration Date
DRONE SAFETY FEATURES MUST BE PRESENT AND IN GOOD OPERATIONAL CONDITION.
ALL DRONES MUST COMPLY WITH STATE AND FEDERAL LAW.
FLIGHT INFORMATION
7. Purpose of Use:
9. Date(s) and Times:
8. Area Requested:
10. Maximum Altitude:
Permission is hereby granted to conduct this activity with the following conditions:
● Use shall be as described above. Requestor is responsible for drone and any damages.
● No flight over or filming of people not associated with your group.
● Filming is for personal use and will not be used for commercial purposes (no money or consideration exchanged).
● I understand I am required to display the FAA-issued registration number on the aircraft’s exterior.
● BOR PARKS ONLY: For safety and security reasons, drone use is not permitted within 2,000 feet of a dam or its appurtenant
facilities or within the Primary Jurisdiction Zone (PJZ) as outlined in the detailed map, whichever distance is greater. Anyone
flying drones within those restricted areas will be prosecuted to the fullest extent of the law.
● Additional park-specific restrictions: ___________________________________________________________________________________________
______________________________________________________________________________________________
● Unsafe conditions or failure to comply with the conditions above will result in permit termination.
● A $______________ fee has been collected by ________________________________________. Receipt #_______________________
Issuer:
Permit Valid (from): (to):
Authorizing Signature: Date:
Requestor Signature: Date:
By signing, you agree to the terms of this Permission Form and the FAA Small Unmanned Aircraft System Rules.
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Personal Drone Use Flight Permission Form Fillable 1 (Utah DRE)

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Completed 26 June 2021

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