Application for Active Military Personnel

Paul R. LePage
Governor
State of Maine
(207) 287-3531 / / Douglas A. Farnham
Brigadier General
Commissioner
(207) 430-6000
Department of Defense, Veterans and Emergency Management
33 State House Station (Attn: TAA)
Camp Keyes, Augusta, Maine 04333-0033
Telephone: 207-430-5778

Application for Active Military Personnel

Day-Use Park Pass

Please complete the following fields of information.

Last Name: ______First Name: ______Middle Initial: ____

Date of Birth: ______SS#: ______Branch of Service: ______Rank: ______

Maine Driver’s License #: ______ (or) State ID # ______

Home of Residence (address): ______

Telephone #: ______Email: ______

Park passes may be picked up in person or you can apply by mail.

Ø Pick up in person – you will need to present proof of active duty service, such as statement of service from commanding officer verifying service and rank or show military ID card. You will also need to provide some form of proof that you are a Maine resident.

Ø Mail (include a self-addressed, stamped envelope). If mailing application,
include a statement of service from commanding officer verifying service, rank and residency. Forward application to the address shown in above letterhead.

______
(Service Member’s Signature)

(FOR OFFICE STAFF USE ONLY)

Date Issued: ______Issued by: ______Pass #: ______

SEE REVERSE SIDE FOR ELIGIBILITY CRITERIA AND OTHER INFORMATION

AD_Park Pass 20170802

Eligibility criteria and other information for Active Enlisted Military Personnel Day-Use Park Pass

1. Military member’s home of residence is Maine.

2. Military member is serving in an enlisted grade in the armed forces as defined in 10 United States Code, Section 101(a)(4).

Passes issued are valid for 12 months and may be renewed upon verification of continuing eligibility.

Pass entitles holder, and the holder’s spouse and children when accompanied by the holder, to admission free of charge to all state parks and historic sites.

Passes are non-transferrable and may not be used by anyone other than the holder. Failure to abide by this will result in a loss of privileges.

AD_Park Pass 20170802