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PERMISSION TO USE PRIVATE PROPERTY FOR FILMING WITHIN CITY OF PALMDALE TO: Antelope Valley Film Office 42035 12th Street West, Ste. #103 Lancaster, CA 93534 Phone: 661‐510‐4231 www.avfilm.com The undersigned is the owner /lessee of the real property located at the following address: , City of Palmdale, CA (zip) Name of Business (if applicable): I have granted permission to: (Film Production Company / School) To use my property for the purpose On the day/date from to Further, I hereby hold harmless and agree to indemnify the City of Palmdale, its officers, employees, servants, agents and volunteers against any claims, demands, or liability arising out of the permittee’s conduct or activities while on, or using, my property in connection with any filming permit(s) issued by the City of Palmdale. I certify under penalty of perjury that the foregoing is true and correct. Executed at California on this of Signed: (Owner/Lessee ) Telephone: For Office Use Only: Insurance ( ) Hold Harmless ( ) Location ( ) Notification ( )