Lake Andrew Landowner Opt-Out Form

This form is to give notice that AIS Herbicide Control WILL NOT occur adjacent to Named Landowner property. Form not submitted by Landowner adjacent to treatment area will be considered approval of AIS control treatment.

Lake Andrew Association has hired Clarke Aquatic Solutions/Solitude to treat the lake for Curly Leaf Pondweed after ice out in the Spring of 2024.

Name

First Name

Last Name

Phone

(###)

###

####

AIS Treatment

NO I do not want AIS Treatment or YES I do want AIS Treatment

Lake Andrew,Address

Lake Andrew Street Address