Petition for Land Grant

Group Name:

___________________________________________________________

Group Contact Information: (you must choose a memeber of your group to act as a Liaison to the RGK for any matters concerning your Land Grant.)

Primary Contact:

Name:

_______________________________________

Phone Number:

_______________________________________

Secondary Contact:

Name:

_______________________________________

Phone Number:

_______________________________________

Please circle only one of the available answers.

Type of Group:	Company	Household
Type of Parcel:	New Land Grant	Land Grant Addition

Please describe your sedired location using existing Land Grans as points of reference:

___________________________________________________________

For RGK Use Only:

Date:____________

Group Type Approved:

YES

CORRECTED

Reason:	_____________________________
Condition:	_____________________________

Parcel Type Approved:

YES

CORRECTED

Reason:	_____________________________
Condition:	_____________________________

Qualifications: Registered with Amtgard, Kingdom of the Emerald Hills? YES NO
Existence of > 6 months? YES NO If no, when eligible: ____________________
Minimum 150 Kingdom Work Hours completed as of: ____________________

Land Grant approved and finalized:____________________
Parcel #: ____________________
RGK Secretary Initials: ________

FORM: Land Grant Request
Ver. 1, Rev. 1

Page 1 of 1

12/13/00