DD_Form_2401_Request_for_Airfield_Landing_by_Civil_Aircraft.pdf

CIVIL AIRCRAFT LANDING PERMIT

Read Privacy Act Statement on back before completing this form.

If additional space is required, continue on back identifying by item number.

OMB No. 0701-0050

SECTION I - INFORMATION REQUIRED FROM USER

Permission is requested to use the listed military airfield(s). It is understood and agreed that:

a. Except for weather alternate use or emergencies, I or my agent will contact each installation commander at least 24 hours prior to each landing for final clearance instructions.

The remarks section of the flight plan will include user name and permit identification number.

b. When required, I or my agent will obtain diplomatic or overflight clearance when operating over international borders.

c. Commanders of military installations may restrict civil aircraft operations to preclude interference with military activities or to protect national security.

d. This permit does not necessarily entitle my aircraft to receive aviation fuel, oil, or other services from U.S. Government sources.

e. On-board personnel are not authorized activities except for purposes directly connected with this permit.

f. Use is limited to the listed aircraft, period indicated, purpose stated, and conditions shown, and is not transferable.

g. An approved copy of this permit must be aboard each aircraft using the military airfield.

1. USER

a. NAME

b. RELATIONSHIP TO PARENT ORGANIZATION (If any)

c. ADDRESS (Street, City, State, Zip Code)

2. NAME OF AIRFIELD(S) TO BE USED

3. ARE PILOTS INSTRUMENT

RATED AND CURRENT? (X one)

YES

NO

4. PURPOSE OF USE

5. AIRCRAFT DATA

a. MANUFACTURE b.

MODEL

c. REGISTRATION

NUMBER

d. CAPACITY

e. MAX

GROSS

TAKE-OFF

WEIGHT

(Pounds)

(1)

CREW

(2)

PASSENGER

f. EQUIPMENT

(1) TWO-WAY

RADIO

(2) STROBE

WARNING

LIGHTS

YES NO

(3) TRANS-

PONDER

(4) IFR CAPA-

BILITIES

YES NO YES NO YES NO

6. CERTIFICATION BY INDIVIDUAL OR AUTHORIZED COMPANY REPRESENTATIVE

Applicant and agents have read, understand, and will comply with all pertinent parts of applicable regulations listed in Note 1 and local supplements, directives, and orders. Such compliance is an express condition of this permit. I certify that the information contained in this permit is true to the best of my knowledge and belief. As a corporate representative, I certify that I have authority to certify this information on behalf of the corporation and hereby designate the aircraft commander as our agent on all matters arising from the use of this permit.

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE c. TELEPHONE NO.

(Include Area Code)

d. SIGNATURE (Blue Ink) e. DATE SIGNED

(YYYYMMDD)

DD FORM 2401, JAN 2008 PREVIOUS EDITION IS OBSOLETE.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. SEND COMPLETED FORM TO THE ADDRESS IN NOTE 2 ON BACK.

The public reporting burden for this collection of information is estimated to average 10 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 the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon, Washington, DC 20301-1155 (0701-0050). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Adobe Professional 7.0

SECTION II - FOR USE BY APPROVING AUTHORITY

DD FORM 2401 (BACK), JAN 2008

7. PERIOD OF USE

a. FROM (YYYYMMDD) b. TO (YYYYMMDD)

8. FREQUENCY OF USE 9. IDENTIFICATION NO. 10. THIS PERMIT SUPERSEDES

PERMIT NO. (Identification No.)

11. THIS PERMIT IS GRANTED ON PRIOR EXECUTION OF DD FORMS 2400 AND 2402

a. DD FORM 2400 (Dated and Filed) b. DD FORM 2402 (Dated and Filed)

12. CREDIT AUTHORIZED

FOR FUEL ISSUES (X one)

13. LANDING

FEES (X one)

YES

NO

YES

NO

14. APPROVING OFFICIAL

a. TYPED OR STAMPED NAME, TITLE AND ORGANIZATION b. SIGNATURE

c. DATE SIGNED (YYYYMMDD)

IF ADDITIONAL SPACE IS REQUIRED, CONTINUE HERE (Refer to item number)

PRIVACY ACT STATEMENT

AUTHORITY: 49 U.S. Code, Section 44502(d).

PRINCIPAL PURPOSE(S): When partially completed, indicates desire of an individual or corporation to operate civil aircraft into a military airfield; when validated by a military approving authority, grants an individual or corporation permission to land civil aircraft at a military airfield.

ROUTINE USE(S): None.

DISCLOSURE: Voluntary; however, failure to provide this information will result in an individual or corporation being unable to operate civil aircraft into a military airfield.

This form is available under DefenseLINK, Publications.

ARMY NAVY AIR FORCE

NOTE 1

NOTE 2

AR 95-2

Can be viewed at: http://books.army.mil/ cgi-bin/bookmgr/Shelves

COMMANDER

USAASA, ATTN: ATAS-AS

BLDG 1466

9325 GUNSTON RD, SUITE N319

FT BELVOIR, VA 22060-5582

(703) 806-0686

32 CFR 766

Can be viewed at: http://calp.navfac.navy.mil

COMMANDER

NAVAL FACILITIES

ENGINEERING COMMAND

CODE: REAT

WASHINGTON NAVY YARD

1322 PATTERSON AVE. S.E., SUITE 1000

WASHINGTON, DC 20374-5065

(202)685-9202

AFI 10-1001

Can be viewed at: http://afpubs.hq.af.mil

HQ USAF/A30-AC

1480 AIR FORCE PENTAGON RM 5E857

WASHINGTON, DC 20330-1480

(703) 697-5967