Application For The America The Beautiful - The National Parks And Federal Recreational Lands Access Pass Page 2
Download a blank fillable Application For The America The Beautiful - The National Parks And Federal Recreational Lands Access Pass in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For The America The Beautiful - The National Parks And Federal Recreational Lands Access Pass with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3NPS Form 10-596 (Rev. 08/2017)
OMB Control No. 1024-0252
Expiration Date 9/2020
National Park Service
APPLICATION FOR MAIL ORDER SALES OF THE
AMERICA THE BEAUTIFUL – THE NATIONAL PARKS AND FEDERAL
RECREATIONAL LANDS ACCESS PASS
U.S. Department of the Interior - Bureau of Land Management, Fish and Wildlife Service, Bureau of Reclamation, National Park Service
U.S. Department of Agriculture - Forest Service - U.S. Army Corps of Engineers
Your application for an Access Pass must include:
Product #209291
1.
This completed, signed application form.
2.
Photocopy of documentation issued by Social Security Disability, Office of Veterans Affairs and/or a licensed physician
that demonstrates permanent disability.
3.
Photocopy of documentation issued by an authorized U.S. agency that demonstrates U.S. citizenship or permanent
residence (driver's license, passport, state issued ID).
4.
Payment of the processing fee by Credit Card.
5.
For a pass replacement, please submit the original worn pass.
**Do Not Send Original Documents**
Please Print Clearly - Your name should appear as it does on your Photo ID
Full Name
Street
City
State
-
Telephone
Zip Code
E-Mail Address
By submitting this application:
I hereby affirm that I am a citizen of or domiciled in the United States, and that I have been medically determined to have a
permanent physical, mental, or sensory impairment that severely limits one or more major life activities. Major life activities
include functions such as: caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, etc.
(Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC § 705 20)).
_______________________________________________________
Date
_______________
Signature:
Payment
American Express
Discover
Credit Card:
Visa
Master Card
Security Code
Credit Card Number
Date
Your credit card will be billed $10 at the time of shipment.
Send your completed Application to:
Questions:
fedrecpass@usgs.gov
USGS
1-888-ASK-USGS
Attn: Access Pass
Box 25286
(1-888-275-8747)
Denver, CO 80225
Federal Law 18 U.S.C. 1001 makes it a crime in any matter within the jurisdiction of any department or agency of the
United States for any person knowingly and willfully to falsify, conceal, or cover up by any trick, scheme, or device a
material fact; to make any materially false, fictitious, or fraudulent statement or representation; or to make or use any
false writing or document knowing that it contains a materially false, fictitious or fraudulent statement or entry.
Violations of 18 U.S.C. 1001 are punishable by fines of up to $10,000, imprisonment of up to five years, or both.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For The Public Housing And/or The Section 8 Housing Choice Voucher Program Sheet
Business
Nps Form 10-930s - Application For Special Use Permit (short Form) - National Park Service - U.s. Department Of The Interior
Legal
Form Edc - Taxpayer Application For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Edc - Taxpayer Application For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Edc - Taxpayer Application For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Form Edc - Taxpayer Application For The Qualified Equity And Subordinated Debt Investments Tax Credit
Financial
Related Categories
Parent category: Legal