Taxi Pass Program Application & Renewal

To apply for Taxi Passes, or to renew for another year, you will need to fully complete this form and upload your documents. You must submit your documents with your application, or your application will not be processed.

If you are having trouble with this form, please call (780)624-1000.

Before you start:

Please make sure you have your documents ready to upload.

If you are using your phone, you can take a picture of your documents when asked for them in the form, or upload photos from your photo album. Your picture needs to be clear and readable. Please choose Large as the file size when uploading.

You will need to upload these documents:

1. Proof of Residency that shows your Peace River STREET address. A box number is not Proof of Residency. Examples:
   • Your ID with your STREET address
   • Your lease or a letter from your landlord
   • A bill, bank statement or government letter mailed to your STREET address
   • A utility bill. Utility bills will show the service address even if mailed to a Box number.
2. One of the following documents, depending on which category you are applying for:
   • AISH recipient – AISH card, or letter from your AISH worker
   • Low Income or Disability – Notice of Assessment or Income Tax Summary for the current tax year, for both you and your partner if you live with them
   • Student – Letter from Northern Lakes College showing your enrolment dates
   • Senior – Proof of Age, such as ID or birth certificate ***Note that as of Aug. 1, 2021 Seniors will also need to provide a Notice of Assessment or Income Tax Summary

You can get a copy of your Income Tax Notice of Assessment by registering for the Canada Revenue Agency My Account. www.canada.ca/my-cra-account

Once you have submitted your application and documents it will take up to 5 business day for your application to be processed. You will be contacted by phone or e-mail whether or not you are approved.

LOW INCOME REFERRAL:
If your situation has changed since you filed your Income Taxes, or if you cannot get a copy of your Income Tax information, you can provide a referral from a Social Services Agency that you are working with, such as Income Support, Alberta Works, the Women’s Shelter, Sagitawa Friendship Centre, the Food Bank, etc. The Low Income Agency Referral Form is available below. You can submit the signed form when you are asked to upload Income Verification on this form.

Low Income Agency Referral Form (PDF | 115 kb)

Application form:

Applicant Legal Name *

First

Last

Your name as it appears on your ID

Preferred Name

Do you go by a name different from your legal name?

Birth Date *

Primary Phone *

We are unable to contact you by text.

Primary Phone Type *HomeMobileWorkOther

Alternate Phone

Alternate Phone TypeN/AHomeMobileWorkOther

Email

Do you hold a Taxi Driver Permit in the Town of Peace River? *

• YES
• NO

Taxi Drivers are not eligible for the Taxi Pass Program. If you get a Taxi Driver Permit while you are on the program, you will no longer be able to purchase passes while you hold the permit. You are also not able to be named as an Alternate Purchaser for another Taxi Pass Client.

Please Choose One: *

• Applying for the first time
• Renewing, already on the program
• Changing to a new category

Residence

You must live in the Town of Peace River to qualify for the Taxi Pass Program.

PEACE RIVER STREET ADDRESS *

MAILING ADDRESS

If it is different from your Residence:

POSTAL CODE *

Attach a copy of one of the following. A Box number is not proof of residence.

• ID with your STREET address
• Your lease or a letter from your landlord
• A bill, bank statement or government letter mailed to your STREET address
• A utility bill. Utility bills will show the service address even if mailed to a Box number.

Are you able to provide a copy of your proof of residence now? *

• Yes
• No

Proof of Residence is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Residence to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Residence Verification *

Click or drag a file to this area to upload.

Eligibility Category

If you are unsure which category you qualify for please call 780-624-1000

Eligibility Category *

• AISH (Assured Income for the Severely Handicapped) recipient
• Senior age 65 and over
• Registered Student at Northern Lakes College
• Low Income – Individual ($15,000 per year or less)
• Low Income – Family (Combined Income $25,000 per year or less)
• Disability

Eligibility Verification

• Attach a copy of your proof of age, for example your ID or birth certificate with your birthdate.
• Attach a copy of your AND your partner’s (if applicable) Notice of Assessment or Income Tax Summary for the most recent year. Income levels are based on the Alberta Seniors Supports Program.
• Income Thresholds for Seniors: Single Individual: Less than $28,785 Combined Income for a Senior Couple: $46,745 or less

Are you able to provide a copy of your ID or birth certificate now? *

• Yes
• No

NEW AS OF AUGUST 1, 2021, Seniors must submit proof of income.
If you are submitting this form before August 1st, 2021 please contact Community Services at 780-624-1000.
You can bypass the requirement for entering income by entering '0' in the income field below and select 'No' when prompted to provide your proof of income.

Proof of age is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of age to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Age Verification *

Click or drag a file to this area to upload.

Do you live with a spouse or partner? *

• NO, I do NOT live with a spouse or partner.
• YES, I live with a spouse or partner.

My Income from Line 15000 on Notice of Assessment or Income Tax Summary *

My Partner's Income from Line 15000 on Notice of Assessment or Income Tax Summary *

Total Income (must be $46,745 or less) *

Add the numbers entered above.

Are you able to provide a copy of your Notice of Assessment or Income Tax Summary for the current year now? *

• Yes
• No

Proof of your income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Your Income Verification *

Click or drag a file to this area to upload.

Are you able to provide a copy of your Partner's Notice of Assessment or Income Tax Summary for the current year now? *

• Yes
• No

Your Partner's Income Verification *

Click or drag a file to this area to upload.

Proof of your partner's income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Partner's Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

• Attach a copy of all 3 parts of your CURRENT AISH benefit card, or a letter from your AISH worker.
• Every January you will need to submit a copy of your new AISH card, and proof of residence.

Are you able to provide a copy of your AISH card or a letter from your AISH worker now? *

• Yes
• No

Proof of AISH benefits is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of AISH Benefits to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

AISH Verification *

Click or drag a file to this area to upload.

• Attach proof of enrolment showing your start and end dates. The College will provide a letter upon request.
• You are eligible for passes while you are attending school, please indicate start and end dates for consecutive terms (i.e. September 1 - June 26) You can reapply in the fall if you are a returning student.

Start Date

End Date

Are you able to provide a copy of your proof of enrolment now? *

• Yes
• No

Proof of enrolment is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Enrolment to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Enrolment Verification *

Click or drag a file to this area to upload.

• To qualify for Low Income as an Individual you must answer yes to the following questions.
• You must attach a copy of your Notice of Assessment or Income Tax Summary for the current year.
• Your income on Line 15000 must be $15,000 or less.
• You will need to provide proof of income in May every year.

Low Income - Individual *

• I do not live with a spouse or partner

I do not have minor children living with me *

• I do not have minor children living with me

My income is less than $15,000. *

• My income is less than $15,000

Are you able to provide a copy of your Notice of Assessment or Income Tax Summary for the current year, or a signed copy of the Low Income Agency Referral now? *

• Yes
• No

Proof of income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Income Verification *

Click or drag a file to this area to upload.

My family situation is one of the following: *

• I live with a spouse or partner, we do not have minor children
• I live with a spouse or partner; we have minor children who live with us
• I do not live with a spouse or partner, I have at least one child under the age of 18 who lives with me.

My Income from Line 15000 on Notice of Assessment or Income Tax Summary *

My Partner's Income from Line 15000 on Notice of Assessment or Income Tax Summary *

Total Family Income (must be $25,000 or less) *

Add the numbers entered above.

Are you able to provide a copy of your Notice of Assessment or Income Tax Summary for the current year, or a signed copy of the Low Income Agency Referral now? *

• Yes
• No

Proof of your income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Your Income Verification *

Click or drag a file to this area to upload.

Are you able to provide a copy of your Partner's Notice of Assessment or Income Tax Summary for the current year now? *

• Yes
• No

Your Partner's Income Verification *

Click or drag a file to this area to upload.

Proof of your partner's income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Partner's Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

• To qualify for the Disability category you must answer yes to questions below
• You must attach a copy of your Notice of Assessment or Income Tax Summary for you and your partner (if applicable) for the current year.
• Single Individual: Less than $15,000 Combined Income for a Family: $25,000 or less.
• Family is defined as living with a spouse or partner with or without dependent children or a single parent living with their dependent children.
• * If you receive AISH please apply under the AISH category.

I have a physical or mental disability. Please do not submit medical information unless it is requested. You will be informed if your application requires further assessment, in most cases this is not necessary. *

• Yes
• No

Do you live with a spouse or partner, do you have at least one dependent child who lives with you? (A dependent child is a child you are the parent or guardian of and who is under 18) *

• NO, I do NOT live with a spouse or partner or dependent children
• YES, I have minor children who live with me, I DO NOT have a spouse or partner.
• YES, I live with a spouse or partner.

My Income from Line 15000 on Notice of Assessment or Income Tax Summary *

My Partner's Income from Line 15000 on Notice of Assessment or Income Tax Summary *

Total Family Income (must be $25,000 or less) *

Add the numbers entered above.

Are you able to provide a copy of your Notice of Assessment or Income Tax Summary for the current year now? *

• Yes
• No

Proof of your income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Your Income Verification *

Click or drag a file to this area to upload.

Are you able to provide a copy of your Partner's Notice of Assessment or Income Tax Summary for the current year now? *

• Yes
• No

Proof of your partner's income is required to process your application. If you are unable to upload the file to this form directly please call Community Services at (780)624-1000 for assistance. You can also e-mail your Partner's Proof of Income to [email protected], in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

Your Partner's Income Verification *

Click or drag a file to this area to upload.

FOIP Disclaimer

The information on this form is being collected in accordance with the Freedom of Information and Protection of Privacy Act (FOIP) for the purpose of the Town of Peace River Taxi Pass program application. This information is protected by the privacy provisions of the FOIP Act. If you have any questions about the collection or use of this information, please contact the FOIP Coordinator at the Town of Peace River, at P.O. Box 6600, Peace River Alberta, T8S 1S4, or phone 780-624-2574.

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