Grant application

Service des finances

1333, boul. Chomedey, bureau 101 C.P. 422, succ. Saint-Martin Laval (Qu?bec) H7V 3Z4 T?l. : 450-978-5700

Grant application to promote support for seniors aged 65 and older

Grant for 2021

Please save this form on your computer before filling it out.

Grant application

Basic - $150

Guaranteed income supplement recipient - $300

Complete section A. Section B must be completed by the landlord of a tenant applicant

A- Applicant

Tenant

Owner

Other

Explain:

1. APPLICANT IDENTIFICATION

___________________________________________________

Last and first names (please print)

Preferred language :

French

English

Date of birth : ________________________

Year-Month-Day

Gender

F

M

Phone number : ___________________________ Email address: _________________________________________

The grant is shared :

Yes

No

______________________________________

Last and first names of the co-beneficiary (please print)

Date of birth : ________________________

the co-beneficiary

Year-Month-Day

2. INFORMATION ON THE ELIGIBLE DWELLING OR HOUSING UNIT ON MAY 1ST 2021

_____________

___________________________________________________

_____________________

Street no.

Street name

Apartment

_Laval_______

_____________

City

Postal Code

Moving after May 1st 2021?

Date : ________________________

Year-Month-Day

New address : ___________________________________________________

I declare to be a resident of City of Laval as of May 1st, 2021.

___________________________________________________ Applicant's signature

________________________ Date Year-Month-Day

B- Landlord's declaration (To be completed only if the applicant is not the owner at the address listed above) I declare that the applicant mentioned above was my tenant on May 1st, 2021.

___________________________________________________

___________________________

Last and first names (please print)

Telephone

___________________________________________________ Signature

___________________________ Date Year-Month-Day

For 2021, any person aged 65 or over residing on the territory of the city of Laval on May 1st, 2021 as a tenant or owner of a dwelling or dwelling unit acting as their primary residence can receive, if it meets the eligibility requirements under Regulation L-12221:

? $ 150 per dwelling or dwelling unit; or

? $ 300 per dwelling or dwelling unit, if this person receives the guaranteed income supplement paid by the Government of Canada under the law of the old age security.

Documents required in addition to the grant application form: 1. A copy of a monthly invoice covering May 1st 2021 billed to the applicant's name and address (Electricity, telephone, cable, etc.). If you are unable to provide such a document, you have to provide us a copy of your lease or lease renewal letter for the same period. 2. If this is your first application, you must provide proof that you are aged 65 or over on May 1st 2021 (health insurance card, driver's license, birth certificate, etc.) 3. For an application of $ 300, you must attach a copy of the T4A (OAS) (2020) provided by the Canada Revenue Agency or a confirmation of receipt of the guaranteed income supplement issued by Employment and Social Development Canada. You must hatch your social security number. 4. If you are a tenant, section B must be signed by your landlord proving your eligibility

A City representative may require other documentation to verify compliance with the eligibility requirements for the grant program. Incomplete applications will be returned to the applicant.

Since 2017, citizens living in rooms, intergenerational housing or with relatives are eligible.

If you decide to share the amount of your grant with your spouse or roommate, you must indicate it to us at the place provided for this purpose. This person must also be aged 65 and older and provide a proof of age. Only one check will be issued for the full amount to both names mentioned on the application form.

The grant application form, including all required and compliant documents, must be sent to the City of Laval by mail or email at the latest on April 30th 2022 at the following addresses:

By mail : Service des finances 1333, boul. Chomedey, bureau 101 C.P. 422, succ. Saint-Martin Laval (Qu?bec) H7V 3Z4

By email: Taxation65ans@laval.ca

Reminder : ? Your proof of residence (monthly invoice, see point 1) ? Sign your form at section A ? If you move, you must provide your moving date and your new address ? Your proof of age (for new application only).

Payment of the grant will be issued on October 1st, 2021 for all compliant applications received before June 30th 2021. A monthly mailing will be done thereafter for the balance of forms received after June 30th 2021.

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