"Visitor Application Form" - Maine

Visitor Application Form is a legal document that was released by the Maine Department of Corrections - a government authority operating within Maine.

Form Details:

  • Released on May 8, 2020;
  • The latest edition currently provided by the Maine Department of Corrections;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Maine Department of Corrections.

ADVERTISEMENT
ADVERTISEMENT

Download "Visitor Application Form" - Maine

Download PDF

Fill PDF online

Rate (4.4 / 5) 48 votes
MAINE DEPARTMENT OF CORRECTIONS
VISITOR APPLICATION
DIRECTIONS: Carefully read all parts of this application and complete all sections that apply to you and any
minor you wish to bring to visit. Incomplete applications will not be processed and false information may
result in denial of visiting privileges.
Prisoner’s Name: ________________________________________________ MDOC # _________________
SECTION 1: VISITOR INFORMATION (ONLY ONE VISITOR’S NAME ON EACH APPLICATION)
Visitor’s Printed Name: _______________________________________
Male
Female
Date of Birth: __________________ Last four (4) digits of Social Security Number: ____________________
Previous other legal name(s): _________________________________________________________________
Visitor’s Street/Road Address (Not a P.O. Box): __________________________________________________
City/Town: ________________________________ State: _______________ Zip code: ___________________
Mailing Address (if different): ________________________________________________________________
Phone Number: __________________ Email Address: _____________________________________________
Driver’s License or State ID #: _________________________________________ State: _________________
Relationship to the Prisoner: __________________________________________________________________
Do you have a Juvenile or Adult Criminal Record?
Yes
No
If yes, list your adjudications and/or convictions: _________________________________________________
(For extra space, use back of form)
LIST THE NAMES OF MINORS THAT YOU WISH TO BRING TO VISIT THIS PRISONER
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
I attest that I am a parent or legal guardian of the above-named minor(s) or that I have authorization by a parent or legal
guardian to bring the above-named minor(s) to visit this prisoner:
Printed Name: _______________________________Signature: ____________________________ Date: ____________
Note: If listing a minor, attach certified copy of minor’s birth certificate, court adoption order, or court guardianship order.
If you are not a parent or legal guardian of the minor, ALSO attach notarized permission from a parent or legal guardian
(other than a prisoner) to bring in the minor as a visitor.
subject of the case unless granted a waiver by the
SECTION 2: RESTRICTIONS
Commissioner, or designee.
1) A minor (person under the age of 18) may not visit unless
4) A waiver will not be granted if it is contrary to a court order
accompanied at the visit by a parent or legal guardian, or by
(e.g., custody order or protection order) or condition of bail or
another adult with the written permission of a parent or legal
conditional release, administrative release, deferred disposition,
guardian and prior approval of Chief Administrative Officer, or
probation, supervised release for sex offenders, supervised
designee. The only exception to this rule is for a minor who is
community confinement, parole, or community reintegration
married or emancipated by court order (attach certified copy of
status of either the prisoner or the victim.
marriage certificate or court order of emancipation).
5) When a prisoner’s parental rights have been terminated, the
2) A prisoner who is currently in the Department’s legal custody
prisoner will not be allowed to receive a visit from the child
for domestic violence, a sex offense, child abuse, or child
while the child is still a minor.
neglect is prohibited from receiving a visit from the victim of
6) If there is a current notification issued under Title 17-A, section
the offense unless granted a waiver by the Commissioner, or
506-A, for a prisoner not to engage in harassing conduct against
designee.
another person, the prisoner will not be allowed to receive a
3) A prisoner who has a current child protection case with DHHS
visit from that person.
is prohibited from receiving a visit from the child who is the
A – 21.4 – B – A – 5/8/20R
Visitor Application
DOC Form
Page 1 of 2
MAINE DEPARTMENT OF CORRECTIONS
VISITOR APPLICATION
DIRECTIONS: Carefully read all parts of this application and complete all sections that apply to you and any
minor you wish to bring to visit. Incomplete applications will not be processed and false information may
result in denial of visiting privileges.
Prisoner’s Name: ________________________________________________ MDOC # _________________
SECTION 1: VISITOR INFORMATION (ONLY ONE VISITOR’S NAME ON EACH APPLICATION)
Visitor’s Printed Name: _______________________________________
Male
Female
Date of Birth: __________________ Last four (4) digits of Social Security Number: ____________________
Previous other legal name(s): _________________________________________________________________
Visitor’s Street/Road Address (Not a P.O. Box): __________________________________________________
City/Town: ________________________________ State: _______________ Zip code: ___________________
Mailing Address (if different): ________________________________________________________________
Phone Number: __________________ Email Address: _____________________________________________
Driver’s License or State ID #: _________________________________________ State: _________________
Relationship to the Prisoner: __________________________________________________________________
Do you have a Juvenile or Adult Criminal Record?
Yes
No
If yes, list your adjudications and/or convictions: _________________________________________________
(For extra space, use back of form)
LIST THE NAMES OF MINORS THAT YOU WISH TO BRING TO VISIT THIS PRISONER
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
Name: _____________________________DOB: _____________ Relationship to Prisoner: _______________
I attest that I am a parent or legal guardian of the above-named minor(s) or that I have authorization by a parent or legal
guardian to bring the above-named minor(s) to visit this prisoner:
Printed Name: _______________________________Signature: ____________________________ Date: ____________
Note: If listing a minor, attach certified copy of minor’s birth certificate, court adoption order, or court guardianship order.
If you are not a parent or legal guardian of the minor, ALSO attach notarized permission from a parent or legal guardian
(other than a prisoner) to bring in the minor as a visitor.
subject of the case unless granted a waiver by the
SECTION 2: RESTRICTIONS
Commissioner, or designee.
1) A minor (person under the age of 18) may not visit unless
4) A waiver will not be granted if it is contrary to a court order
accompanied at the visit by a parent or legal guardian, or by
(e.g., custody order or protection order) or condition of bail or
another adult with the written permission of a parent or legal
conditional release, administrative release, deferred disposition,
guardian and prior approval of Chief Administrative Officer, or
probation, supervised release for sex offenders, supervised
designee. The only exception to this rule is for a minor who is
community confinement, parole, or community reintegration
married or emancipated by court order (attach certified copy of
status of either the prisoner or the victim.
marriage certificate or court order of emancipation).
5) When a prisoner’s parental rights have been terminated, the
2) A prisoner who is currently in the Department’s legal custody
prisoner will not be allowed to receive a visit from the child
for domestic violence, a sex offense, child abuse, or child
while the child is still a minor.
neglect is prohibited from receiving a visit from the victim of
6) If there is a current notification issued under Title 17-A, section
the offense unless granted a waiver by the Commissioner, or
506-A, for a prisoner not to engage in harassing conduct against
designee.
another person, the prisoner will not be allowed to receive a
3) A prisoner who has a current child protection case with DHHS
visit from that person.
is prohibited from receiving a visit from the child who is the
A – 21.4 – B – A – 5/8/20R
Visitor Application
DOC Form
Page 1 of 2
MAINE DEPARTMENT OF CORRECTIONS
VISITOR APPLICATION
Note: For additional restrictions and information, see Department
SECTION 4: CLEARANCE NOTIFICATION
Policy 6.3, Contact with Victims, and Policy (AF) 21.4, Prisoner
Applications are processed as quickly as possible. All visitors to
Visitation, which are available at each facility and at the Maine
facilities must wait until a criminal records check has been
completed. This process is done by the State Bureau of
Dept. of Corrections website at
Identification and may take several weeks. You will be notified in
http://www.maine.gov/corrections/PublicInterest/policies.shtml
writing if you are not approved. The prisoner will notify you if
SECTION 3: STATUTES
you have been approved. Please do not call the facility asking
whether you have been approved.
M.R.S.A. TITLE 17-A, SECTION 757
A person is guilty of TRAFFICKING IN PRISON
Each adult visitor is required to present government-issued
CONTRABAND if that person intentionally conveys or
picture identification, such as a driver’s license. A minor
attempts to convey contraband to any person in official custody.
visitor may be required to present a government-issued
Contraband, for the purpose of this section, is defined as a
identification card or a certified birth certificate.
dangerous weapon, any tool or other item that may be used to
SECTION 5: PUBLIC TRANSPORTATION
facilitate escape or any other thing that a person confined in
There is no public transportation to or from any Maine Department
official custody is prohibited by statute from making,
of Corrections facility. Upon request, facility staff will make a
possessing, or trafficking in or a scheduled drug. Examples of
phone available to visitors to call for transportation and will assist
contraband are: guns, knives, cutting blades, files, drugs,
in facilitating transportation between the facility and nearby public
including marijuana, and cellphones. Punishment may include
transit terminals, if any.
imprisonment for up to 5 years.
SECTION 6: VISITATION MONITORING
M.R.S.A. TITLE 17-A, SECTION 757-A
It is possible that communications by or with prisoners made
A person is guilty of TRAFFICKING OF TOBACCO in an
during visits will be listened to and/or recorded by an Investigative
adult correctional facility if that person intentionally conveys or
Officer or other employee of the Maine Department of Corrections
attempts to convey tobacco or tobacco products to a person
authorized to exercise law enforcement powers. This does NOT
confined in an adult correctional facility that has banned the use
apply to attorney/client privilege information.
of tobacco or tobacco products by prisoners. Punishment may
include imprisonment for up to 6 months.
SECTION 7: READ CAREFULLY
I understand and acknowledge the information given above. I
THE MAINE STATE PRISON, THE MAINE
acknowledge that I am subject to search prior to and as a
CORRECTIONAL CENTER (EXCEPT FOR SOUTHERN
condition for visiting at Department of Corrections facilities. I,
MAINE RE-ENTRY CENTER) AND MOUNTAIN VIEW
and any minor I bring with me, will abide by the visitation
HAVE BANNED THE USE OF TOBACCO OR TOBACCO
rules set out in Department Policy (AF) 21.4, Prisoner
PRODUCTS BY PRISONERS.
Visitation, available at each facility and at the Maine Dept. of
M.R.S.A. TITLE 17-A, SECTION 757-B
Corrections website at
A person is guilty of TRAFFICKING OF AN ALCOHOLIC
http://www.maine.gov/corrections/PublicInterest/policies.shtml
BEVERAGE in an adult correctional facility if that person
and posted at the facility (including the visitor dress code). I
intentionally conveys or attempts to convey an alcoholic
understand that if I, or any minor I bring with me, violate the
beverage to a person confined in an adult correctional facility.
visitation rules, the visit may be terminated and my visiting
Punishment may include imprisonment for up to 6 months.
privileges may be suspended.
The above is an overview. Please refer to Department Policies (AF) 21.4, Prisoner Visitation, and 6.3 Contact with Victims,
available from each facility and at the Maine Department of Corrections website
http://www.maine.gov/corrections/PublicInterest/policies.shtml
for a full explanation.
Applicant’s Printed Name:
__________________________________________________________________
Signature of Applicant: _______________________________________________ Date: ________________
Return completed application to:
Maine State Prison
Bolduc Correctional Facility
807 Cushing Road
516 Cushing Road
Warren, ME 04864
Warren, ME 04864
Southern Maine Women’s Re-Entry Center
Mountain View Correctional Facility
1182 Dover Road
c/o Maine Correctional Center
Charleston, ME 04422
17 Mallison Falls Road
Windham, ME 04062
Maine Correctional Center
17 Mallison Falls Road
Windham, ME 04062
A – 21.4 – B – A – 5/8/20R
Visitor Application
DOC Form
Page 2 of 2
Page of 2