Borough of Butler Reservoir Fishing Permit * Fields in red are required Butler Water Department AGREEMENT In consideration for the granting of this permit by the Borough of Butler, permittee hereby agrees that the Borough of Butler will not be held responsible for, or liable for any act done or omitted by the grantor, or its agents, third party persons at or about the premises and that said grantor will not be liable for any damages to the person or property of the said permittee, accepts the premises in its present condition and has notice that they proceed onto the property to carry out the purpose of the permit at their own risk. Name: Street Address: Mailing Address (if different): Phone #: City: State: Zip Code: Email Address: Vehicle License Plate Number: License Plate State: Current NJ Fishing License Number: Please upload a copy of your current / valid NJ Fishing License : Payer Information Billing Name: Address: Address 2: City: State: - - AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP Code: Daytime Phone: E-mail Address: Payment Information Payment Amount: Select Amount $10.00 - Reservoir Fishing Permit $0.00 - 70+ Years Old Payment Method: ACH Payment (e-Check) Convenience Fee: Enter information as it appears on your check (USA Banks Only) Routing Number: Account Number: Re-Enter Account #: Using the following lower portion of a personal check as an example, enter the information that appears at the bottom of your check. Do NOT include any dashes or spaces. Comments: Terms & Conditions: AGREEMENT In consideration for the granting of this permit by the Borough of Butler, permittee hereby agrees that the Borough of Butler will not be held responsible for, or liable for any act done or omitted by the grantor, or its agents, third party persons at or about the premises and that said grantor will not be liable for any damages to the person or property of the said permittee, accepts the premises in its present condition and has notice that they proceed onto the property to carry out the purpose of the permit at their own risk. I HAVE READ AND UNDERSTAND THE ATTACHED RULES AND REGULATIONS AND HEREBY ATTEST THAT I WILL ABIDE BY THEM AND THE FOREGOING TERMS. NO ICE FISHING - This priviledge can be REVOKED - I agree to the above Terms and Conditions.