Permission Of Access

Permissions of access form

With reference to the following production:

In consideration of the request for audio / video recording as follows:

Location: st Johns wood

Date: 5^th February 2011

Time: 10:00

Please tick / fill in as applicable:

ü  Permission is given

¨ Permission cannot be given

¨ Permission is given subject to the following conditions:

Name (Please print):   Julie Lang                                                        Date: 5^th February 2011

Position: House owner

Address:  37 Dolfnew Avenue

                     st johns wood

                        Middlesex

                         Nw6  4zf

Contact telephone number: 079839944657

Signature: J.M.Lang