ANNUAL HENDERSON BEACH PASS REBATE REQUEST (RESIDENTS ONLY)

2. Please complete the online form below to submit your resident rebate request. DESTIN RESIDENTS ONLY

4. SECTION 1: APPLICANT INFORMATION

6. First Name*

7. Last Name*

9. Resident Address1*

11. Unit, Apt, etc.

13. City*

14. State*

15. Zip*

17. Preferred Phone Number*

18. Alternative Phone Number

20. Email Address*

22. SECTION 2: PLEASE COMPLETE THE FOLLOWING

24. Applicant must submit a copy of the following:
    Attachments can be uploaded in the following formats: .jpg, .png, .pdf

    Attachments can be uploaded in the following formats: .jpg, .png, .pdf

26. Valid Florida Driver's License or State of Florida Identification Card*

    Please upload a copy of your valid Florida Driver's License or State of Florida issued Identification Card that includes the applicant street address confirming the physical address of their residence within the incorporated city limits of Destin.

28. Annual Pass*

    Please upload a copy of your valid Annual State Park Pass

30. Pass Receipt*

    Please upload a copy of your valid receipt of purchase

32. *Limit one rebate per household.

34. ** $30.00 rebate is issued via check and mailed to the address provided.

36. Pass rebates will be processed and mailed during normal business hours.

38. Affirmation*

    1. I hereby affirm that I am a full-time Destin resident, and to the best of my knowledge and belief all of the information I have furnished in connection with this application is true and complete.
40. Any information submitted via online requests may be subject to a public records request.

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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field