Grant application to promote support for seniors aged 65 and older

Service des finances

1333, boul. Chomedey, bureau 101

C.P. 422, succ. Saint-MartinLaval (Québec) H7V 3Z4Tél. : 450-978-5700

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- Appliant Tenant Owner Other Explain:

1. APPLIANT IDENTIFICATION

___________________________________________________ Date of birth : ________________________

Last and first names (please print) Year-Month-Day

Preferred language : French English Gender F M

Telephone number : ___________________________

The grant is shared : Yes No

______________________________________ Date of birth of : ________________________

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

2. INFORMATION ON ELIGIBLE DWELLING OR HOUSING UNIT ON MAY 1ST 2020

_____________ ___________________________________________________ _____________________

Street no. Street name Apartment

_Laval_______ _____________

City Postal Code

Moving after May 1st 2020? Date : ________________________

Year-Month-Day

New address :

________________________

I declare to be a resident of City of Laval as of May 1st, 2020.

_________________________________________________

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)

___________________________

Telephone

___________________________

I declare that the applicant mentioned above was my tenant on May 1st, 2020.

___________________________________________________

Last and first names (please print)

___________________________________________________

Signature Date Year-Month-Day

Grant for 2020

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

For 2020, any person aged 65 or over residing on the territory of the city of Laval on May 1st, 2020 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 the old age security.

Documents required in addition to the grant application form :

1. A copy of a monthly invoice covering May 1st 2020 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, 2020 (health insurance card, driving license, birth certificate, etc.).3. For an application of $ 300, you must attach a copy of the T4A (OAS) (2019) provided by the

Canada Revenue Agency or a confirmation of receipt of the guaranteed income supplement

issued by Employment and Social Development Canada.

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 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,

at the latest on April 30th, 2021 at the following addresss:

Payment of the grant will be issued on October 1st, 2020 for all compliant applications received before July 31st 2020. A monthly mailing will be done thereafter for the balance of forms received after July 31 st

2020.

- 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 od age (for new application only).

By mail :Service des finances 1333, boul. Chomedey, bureau 101 C.P. 422, succ. Saint-MartinLaval (Québec) H7V 3Z4

By email : Taxation65ans@laval.ca

Reminder :