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Updated 4/3/2017
MEMORANDUM TO: CPWD Members FROM: Betsy Luecking, Community Outreach Manager 240-777-1256 SUBJECT: PHOTO IDENTIFICATION CARD FOR COMMISSION MEMBERS Photo I.D. cards are processed strictly by appointment only. To schedule an appointment please visit www.montgomerycountymd.gov/POL/security/appointments.html. Please bring the enclosed completed application form to your appointment. You can obtain an ID at either of the following locations: • Executive Office Building - 101 Monroe Street, Terrace Level, Rockville, MD 20850.
Parking: Available on the street or garage parking is available at the Council Office Building located at 100 Maryland Avenue, Rockville, MD 20850.
• Public Safety Headquarters – 100 Edison Park Drive, 1st Floor, Gaithersburg, MD 20878 Parking: Free parking is available on-site.
PLEASE NOTE: Remember to present a government issued photo ID for identification purposes.
SSD USE ONLY
Include Ticket # here: Proponent Unit:
Security Services Division
Employee Information
Name: ________________________________________________ Date: _________________ First M.I. Last
Department/Division: _______________________________ Work Phone #_________________
Work Address: _________________________________________________________________
***Note: Please Contractors, forRequested Accessof eth dateEnd give Volunteers, __________________Interns: ***
Employee Status
Board Commission Committee OfficialElected Member Member Member
**Authorized Approver **
Print Name:
Signature:
Badging Locations: EOB – Terrace
101
Rockville, 20850 MD
Street Monroe Level PSHQ – SSD / Rm 1112
100 Edison Park Drive
Gaithersburg, MD 20878
SSD HelpTicket Email: #[email protected]
Montgomery County, Maryland REQUEST FOR IDENTIFICATI ACCESSON CARD MCP 163
Rev. 11 /17
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