APPLICATION FOR TOWN OF OYSTER BAY BEACH ID CARD
PLEASE SELECT ONE:
SENIOR CITIZEN (I certify that I am 60 years of age or older)
SENIOR’S SPOUSE CARD
DISABLED
S.S.C. (For persons receiving disability insurance benefits under the social security act)
TOWN CLERK RICHARD LAMARCA
OFFICE OF THE TOWN CLERK
54 AUDREY AVENUE
OYSTER BAY, NY 11771
(516) 624-6343 / (516) 797-7960
townclerk@oysterbay-ny.gov
PLEASE PRINT CLEARLY DATE: _________________
______________
_____________________ ___________________________________
Name of Applicant Date of Birth
___________________________________ ___________________________________
Street Address Driver’s Identification No.
________
___________________________ ___________________________________
Post Office Zip Vehicle License Plate Number
________
___________________________
Email
________
___________________________ ___________________________________
Phone No. Signature of Applicant
!STOP! BEFORE YOU SUBMIT – Did you include all required documents?
FOR OFFICE USE ONLY
I
dentification No. _______________________________ Application Accepted by _______________________________
APPROVED FOR BEACH SEASON 2020 BEACH PHOTO ID CARD DECLINED FOR 2020 5/2020
