California residents that are qualified disabled war veterans, former prisoners of war or recipients of the Medal of
Honor are eli
g
ible to receive a Distin
g
uished Veteran Pass, which entitles the holder to the use of all basic State Park
S
y
stem operated facilities, at no further char
g
e. No fee is required to obtain this pass.
To qualify for the pass, all applicants (veterans) must attach proof of the following as specified in Section B:
1
)
Photoco
py
of valid California Driver License or California Identification Card, and 2
)
Honorable dischar
g
e from service
and
3
)
p
roof of current California residenc
y
, and 4
)
one of the eli
g
ibilit
y
criteria listed in Section B-4 for either Disabled Wa
r
Veteran, Prisoner of War, or Medal of Honor Recipient eligibility. A name change document such as a marriage certificate
or divorce decree is required if the name on any of the identity documents is different from the name on this application.
Note that all certification material will be confidentially retained by California State Parks and cannot be returned.
A. Complete the following information:
A copy of valid CA Driver License or CA Identification Card showing veteran's current California residence address
(interim/temporary not accepted) and
Proof of Honorable Discharge (e.g. DD Form 214 Member 2-4, or VA "Summary of Benefits Letter"*) and
Proof of current California residency using one of the methods listed below. Dates on acceptable documents to meet
requirements MUST be current and bear the veteran's name and corresponding physical address provided on this
application. Applicant cannot claim multiple state residenc
y
for the purpose of this pass.
Current property tax bill showing homeowner's property tax exemption filed in California; OR
California Voter Registration card or affidavit from Registrar of voters; OR
Form 1098T, Tuition Payments Statement showing CA resident in-state tuition paid for most recent tax year; OR
Utility bill (electricity, gas, or cable) statement of charges for most recent three consecutive months; OR
Signed, dated and notarized rental agreement/contract; and
Also include the following attachment(s) for the applicant's specific eligibility qualification as follows:
For DISABLED WAR VETERANS also include all of the following
:
1 -
Proo
f
o
f
service during VA recognized wartime periods.
e.g. DD Form
4 Member
-4,
erti
icate o
Release or
Discharge from Active Duty or VA "Summary of Benefits Letter"*). Recognized service dates must be listed.
2 - A current letter from the United States Department of Veterans Affairs dated within one year of application stating
the veteran has an overall/combined rating at 50% or greater service-connected disability as determined by the
Veterans Affairs’ combined rating table (e.g. VA "Summary of Benefits Letter"*).
For PRISONERS OF WAR also include
:
A letter from the United States Department of Veterans Affairs or copy of personnel records from the
appropriate United States military branch verifying former prisoner of war status.
For MEDAL OF HONOR RECIPIENTS also include
:
A letter from the United States Department of Veterans Affairs or copy of personnel records from the
appropriate United States military branch verifying Medal of Honor recipient status.
C. Submit this application with your certification material by mail or in person to:
MAIL: California State Parks IN PERSON: Park Pass Sales Office
(Allow 8-10 weeks
A
ttn: Distinguished Veteran Pass Program (Applicant must 1416 9th Street - Room 116
for processing)
P.O. Box 942896 be present.) Sacramento, CA 95814
Sacramento, CA 94296-0001
DPR 619 (Rev. 12/2018)(Excel 12/11/2018)(Page 1 of 2)
If you have questions regarding the Distinguished Veteran Pass, contact
FOR DEPARTMENT USE ONLY
1.
3.
4.
(Information on this form is considered personal. See Page 2 for Privacy Notice.)
2.
*"Summary of Benefits Letter" from the United States Department of Veteran Affairs (VA) call (800) 827-1000, voice prompt
"Letters", or visit www.ebenefits.va.gov.
State of California - Natural Resources Agency
DEPARTMENT OF PARKS AND RECREATION
DISTINGUISHED VETERAN PASS APPLICATION
APPLICANT NAME (print or type: First Name, Middle Initial, Last Name)
MAILING ADDRESS
APPLICANT'S ORIGINAL SIGNATURE
- I certify under penalty of perjury, the foregoing is true and correct.
NOTICE TO EMPLOYEES: The information entered on this form is classified as "personal" under the Information Practices Act (Civil Code
(NOTE: All certification material will be confidentially retained by California State Parks and cannot be returned.)
CALIFORNIA STATE PARKS PASS SALES at 1-800-777-0369 ext. 2, or 916-653-8280.
B. Attach the following certification materials with sensitive/confidential information redacted to this application:
For pass terms and conditions, see Page 2.
Section 1798). The Department's Legal Office should be consulted before any disclosure is made.
EMAIL ADDRESS (Username for ReserveCalifornia™)
Distribution: Page 1 - California State Parks; Page 2 - Applicant
PHYSICAL ADDRESS / CITY / STATE / ZIP CODE (if different from Mailing Address, no P.O. boxes)
VERIFIED BY DATE PASS NO.DATEISSUED BY
PHONE NUMBER
()
GENDER (Optional)
TODAY'S DATE
ALL FOUR CATEGORIES (B)
OF CERTIFICATION ATTACHED
CA DRIVER LICENSE / CA I.D. NO.
DATE OF BIRTH
(mm/dd/yy)
MALE FEMALE
CHECK HERE IF APPLYING FOR REPLACEMENT PASS
REASON:
APT NO. CITY / STATE / ZIP CODE
Department of Parks and Recreation Strategic Planning and Recreation Services
Staff Park and Recreation Specialist
1416 Ninth Street, Room 116; P.O. Box 942896, Sacramento, CA 94296-0001 (916) 653-8280
Public Resources Code Section 5011.5.
All information requested on the application is mandatory unless marked as optional.
The applicant will not be issued a Distinguished Veteran Pass.
The information will be used to determine eli
g
ibilit
y
for issuance of Distin
g
uished Veteran Passes which entitle the holder to the
use of all basic State Park S
y
stem operated facilities at no char
g
e except for supplemental fees. Additionall
y
, the information
ma
y
be used to determine eli
g
ibilit
y
for other State Pro
g
rams and to facilitate communication of such eli
g
ibilit
y
.
A
pplications will be retained one calendar
y
ear plus prior calendar
y
ear for audit purposes and statistical data.
Departmental Audits Office or Human Rights Office.
DPR 619 (Rev. 12/2018)(Excel 12/11/2018)(Page 2 of 2)
This is a lifetime pass and is valid for use of the pass holder only. Once pass is received, pass holder may use passcard for applicable
benefits. Although the benefits are lifetime, the pass holder's passcard will need to be renewed every five years. Pass holder agrees to the
Terms and Conditions of this pass and any rules/regulations applicable to California State Parks, as amended from time to time. Violation
may result in pass revocation. Inquire at the location of pass issuance or visit www.parks.ca.gov for the complete list of Terms and
Conditions.
PRIVACY NOTICE
Section 1798.17 of the Civil Code requires this notice be provided when collecting personal information from individuals.
AGENCY NAME DIVISION
TITLE OF OFFICIAL RESPONSIBLE FOR MAINTENANCE OF THE INFORMATION
BUSINESS ADDRESS OF OFFICIAL
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION
THE FOLLOWING ITEMS OF INFORMATION ARE VOLUNTARY, ALL OTHERS ARE MANDATORY
THE CONSEQUENCES, IF ANY, OF NOT PROVIDING ALL OR ANY PART OF THE REQUESTED INFORMATION
THE PRINCIPAL PURPOSE(S) WITHIN THE AGENCY FOR WHICH THE INFORMATION IS TO BE USED
KNOWN OR FORESEEABLE DISCLOSURES OF THE INFORMATION PURSUANT TO CIVIL CODE SECTION 1798.24, SUBDIVISIONS (e) OR (f)
Each individual has the right to review personal information maintained by this agency, unless access is exempted by law.
TELEPHONE NUMBER
DISTINGUISHED VETERAN PASS
Terms and Conditions Overview
The pass is valid unless revoked, at any unit of the California State Park System operated by the California Department of Parks
and Recreation. It is not valid at units operated by federal or local government, private agencies or concessionaires
RESERVATION INFORMATION: Reservations can be made for campsites through ReserveCalifornia™ by calling toll-free at
1-800-444-7275 (TDD 1-800-274-7275), or for Hearst Castle/Año Nuevo tours by calling toll free at 1-800-444-4445.
Pass holders must self-identify as a Distinguished Veteran Pass Holder when making reservations through
ReserveCalifornia™. No priority can be given to pass holders. Visitors reserving accessible campsites are required to possess a
valid Department of Motor Vehicles (DMV) Disabled Placard or license plate and corresponding identification card issued by DMV.
Disabled veterans possessing a valid disabled veteran's license plate and corresponding identification card issued by DMV also
meet the requirement. All requests for accessible campsites must be made at the time of the reservation.
The pass is issued as a personal benefit to the pass holder only. Pass holder may only hold one lifetime discount pass issued
by California State Parks. The pass holder may not lend, loan, reassign, or resell their pass or the privileges allowed by the
pass to anyone else. The pass is non-transferable and non-refundable, and cannot be used in conjunction with any other pass
and/or discount. A lost or damaged pass may be replaced only through reapplication.
The pass may be used any day of the week, including holidays, if space is available. Space is not assured - use of facilities is
on a "first-come, first-served" basis when space is available, unless reservations are made in advance. The pass is not valid for
special events, commercial or group use or for supplemental fees such as additional motor vehicles, sanitation disposal use, etc.
The pass holder is required to present the Distinguished Veteran Pass (photocopies not accepted) and a valid California Driver
License or California Identification Card showing current California residence address (Interim/temporary not accepted), along
with any campsite reservation or tour ticket, and to pay any supplemental fees at the park.
The pass may be used for family camping. Only the campsite occupied by the pass holder is subject to the discount. Any
subsequent campsites reserved by the pass holder, but not occupied by the pass holder will be charged full price. Making
multiple overlapping reservations using pass holder's discount is not allowed and will place pass in jeopardy of revocation. The
pass is not valid for group campsites. The pass holder must be at check-in even when the campsite is reserved in advance.
Information relating to the 5-year renewal process for the passcard will be provided to the pass holder prior to the expiration of
their current passcard. Pass holder should notify the Park Pass Sales Office of any change of name, address, e-mail address,
or telephone number in order to continue to receive benefits. Pass holder cannot claim multiple state residency for the
purposes of this pass and associated benefits.
The pass may be used for entry of one passenger vehicle with a capacity of nine persons or less where a vehicle day use fee is
collected. (To receive pass benefits at self pay locations, place the pass on the vehicle dashboard where it is visible through the
windshield.) The pass may be used for boating for one vessel associated with this vehicle. When a park requires a "ticket per
person" admittance such as for museums, swimming pools, tours, etc., the discount applies only to the pass holder.
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