Disabled Access Pass Application Form

DISABLED ACCESS PASS

Please read before signing form

An ACCESS Pass will be good for a lifetime. We do not plan to maintain records on who has been issured a Pass. If It is lost a new one will need to be purchased. If your passport becomes worn or torn, we will replace that free of charge.

To the Secretary of the Agriculture:

I do hereby awear or affirm that I have been medically determined to be blind or permanently disabled for purposees of receiving benefits under Federal Law, that I am a citizen of the United States or that I am domiciled therein, and that I am duly entitled to be Issued free of charge, one Access Passport, pursuant to the Land and Water conservation

Fund Act of 1965, as amended bt P.L. 96-344.

Javier Bautista