Senior Citizen Appreciation Pass Program Application printable pdf download

Senior Citizen Appreciation Pass Program Application

Fairbanks North Star Borough

809 Pioneer Road • PO Box 71267 • Fairbanks, Alaska 99707-1267 • (907) 459-1000 FAX 459-1100

SENIOR CITIZEN APPRECIATION PASS PROGRAM APPLICATION

The Fairbanks North Star Borough is proud to issue a Borough Senior Citizen Appreciation

Pass. This pass is in recognition of the contributions senior citizens have made to our community.

This pass entitles you to reduced fees at Borough Facilities and on the Transit System and

represents only a small token of our appreciation for your contributions.

Luke Hopkins

Borough Mayor

NAME

_________________________________

ADDRESS

_________________________________

PHONE

______________________________ ---

AGE

_______

DATE OF BIRTH__ _/______/____

Length of time you have lived in the Fairbanks North Star Borough.______________

I attest that the above information is true and complete to the best of my

Knowledge by my signature below

_________________________________

Signature of Applicant

DATE ISSUED: ____________

CARD NUMBER ___________

Senior Citizen Appreciation Pass Program Application