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. 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 upload photos directly to the form. 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 – 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

If you do not submit the required documents your application cannot be processed.

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 at peaceriver.ca/taxi or by calling (780)624-1000. You can submit the signed form when you are asked to upload Income Verification on this form.

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 *

Must be 18 or older

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 communityservices@peaceriver.ca, 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 *

• Senior age 65 and over
• AISH (Assured Income for the Severely Handicapped) recipient
• 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)

Eligibility Verification

• Attach a copy of your ID or birth certificate with your birthdate.
• You may be asked for proof of residence every year.

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

• Yes
• No

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 communityservices@peaceriver.ca, 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.

• 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 communityservices@peaceriver.ca, 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 approval during your enrolment dates only.

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 communityservices@peaceriver.ca, 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 communityservices@peaceriver.ca, 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 communityservices@peaceriver.ca, 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 communityservices@peaceriver.ca, in the e-mail please state your name and that you have submitted a Taxi Pass application through the online form.

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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