REMINDER:
Please provide documentation of proof of age for the Qualifying resident. For example: Driver's License, Birth Certificate, Passport, Immigration Card Military Identification or any other state, local, national or official document containing a birth date of comparable reliability.
Place the document in a SEALED envelop and return it to the Gallery Office within 30 days of submitting this form.
This information will be maintained in the strictest confidence and will be used ony for statistical purposes and to satisfy governmental requirements. Thank you for your assistance and anticipated cooperation.