DOD - BLM/USFS - SPECIAL CHARTERS
FLIGHT #	A/C #		TOTAL PAX
POINT OF DEPARTURE		POINT OF DESTINATION

I CERTIFY THAT NO UNAUTHORIZED WEAPONS/AMMUNITION/EXPLOSIVE DEVICES, OR OTHER PROHIBITED ITEMS ARE IN THE POSSESSION OF THOSE PERSONNEL FROM WHOM I AM THE DESIGNATED MANIFESTING REPRESENTATIVE OR GROUP LEADER, AND THAT THEIR AUTHORIZED WEAPONS HAVE BEEN CLEARED.

DATE	PRINTED NAME (Last, First, MI)	TITLE	SIGNATURE
OFFICE ADDRESS		TELEPHONE #

DOD - BLM/USFS - SPECIAL CHARTERS
FLIGHT #	A/C #	TOTAL PAX
I CERTIFY THAT NO UNAUTHORIZED WEAPONS/AMMUNITION/EXPLOSIVE DEVICES, OR OTHER PROHIBITED ITEMS ARE IN THE POSSESSION OF THOSE PERSONNEL FROM WHOM I AM THE DESIGNATED MANIFESTING REPRESENTATIVE OR GROUP LEADER, AND THAT THEIR AUTHORIZED WEAPONS HAVE BEEN CLEARED.

DATE	PRINTED NAME (Last, First, MI)	TITLE	SIGNATURE
OFFICE ADDRESS		TELEPHONE #