Taxi Pass Application | Town of Peace River

Legal Name

Enter your legal first and last name as it appears on your ID.

Legal First Name

Legal Last Name

Do you have a preferred name different from your legal name?

Yes

If you use a name other than your legal name please check yes.

Preferred Name

What name do you prefer to be called?

Birth Date

You must be 18 or older, unless you are attending Northern Lakes College. Independent Minors age 16 or 17 may apply with a referral, please contact (780)624-1000.

Age

Phone Number

Please enter a phone number so we can contact you about your application.

We will e-mail you important information about your application.

Street Address

Enter the STREET address where you live in Peace River. A box number is not valid proof of residence.

Street Address

Apartment #

Town

Postal Code

Upload Proof of Residence

Attach a photo or document showing your name and street address.
Example:
Lease, utility bill, bank statement or government letter

One file only.
15 MB limit.
Allowed types: jpg, png, pdf, jpeg.
50 MB limit per form.

Do you have a mailing address different from your street address?

Yes

Mailing Address

City/Town

Province

ZIP/Postal Code

Do you hold a Taxi Driver permit in Peace River?

Yes

Taxi Drivers are not eligible for the Taxi Pass program. If you obtain a Taxi Driver permit while you are on the program you will no longer be eligible to purchase passes.

Are you a student at Northern Lakes College?

Yes

Northern Lakes College Proof of Enrolment

Please attach a document from Northern Lakes College confirming you are enrolled and showing your start and end dates.
One file only.
15 MB limit.
Allowed types: jpeg, jpg, png, pdf.
50 MB limit per form.

Do you receive AISH (Assured Income for the Severely Handicapped)?

Yes

AISH Statement

Please upload your AISH statement, ensuring your name, the date and the Budget Info sections are visible. If you do not receive Health Benefits your name and the date will be at the top of the page.
One file only.
15 MB limit.
Allowed types: gif, jpg, png, svg, pdf.
50 MB limit per form.

Are you a Senior age 65 or older?

Yes

Proof of Age

Please upload proof of age, such as ID or a birth certificate.
Maximum 3 files.
13 MB limit.
Allowed types: jpg, png, pdf, jpeg.
50 MB limit per form.

Income - enter your income from Line 15000 of your Income Tax

Proof of Income

Maximum 3 files.
15 MB limit.
Allowed types: jpg, png, pdf, jpeg.
50 MB limit per form.

Are you married or do you live with a partner?

Yes

Partner's first name

Partner's Last Name

Partners Income

Enter your spouse or partners income from Line 15000 of their most recent Notice of Assessment.

Partners Income Upload

One file only.
15 MB limit.
Allowed types: gif, jpg, png, svg, .
50 MB limit per form.

Do you have dependent children under 18 who live with you?

Yes

Dependent child means that you are the parent or legal guardian of the child.

Dependent Children

Please list your children who:

live with you
you are their parent or legal guardian.

To add more children click on the plus icon next to the row, or click on Add.

Name	Age	Birthday	Operations
Name	Age	Birthday

Use of Personal Information

By submitting this form you are consenting to the collection and use of your personal information.

The personal information on this form is collected in accordance with the Section 33 (c) of the Freedom of Information and Privacy Act and is collected for the sole use of the Town of Peace River for the administration of the Taxi Pass Program. If there are any questions about the collection or use of this information, contact the FOIP Coordinator at 780-624-2574, 9911 100 Ave Peace River, AB.

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