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Exemption Form

The document outlines the vehicle exemption policy for the Couchiching First Nation Toll Booth. Vehicles are exempt if they have a passenger with a status card or display a Couchiching exemption sticker. The sticker exemption applies to band members' non-status spouses, common-law partners, or children. The form requests vehicle information and registration copies to apply for exemption stickers for up to three vehicles belonging to a band member.

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112 views1 page

Exemption Form

The document outlines the vehicle exemption policy for the Couchiching First Nation Toll Booth. Vehicles are exempt if they have a passenger with a status card or display a Couchiching exemption sticker. The sticker exemption applies to band members' non-status spouses, common-law partners, or children. The form requests vehicle information and registration copies to apply for exemption stickers for up to three vehicles belonging to a band member.

Uploaded by

Couchiching
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF or read online on Scribd
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Couchiching First Nation Couchiching First Nation

RMB 2027
Toll Booth Initiative R.R. #2
spouse/common law
Exemption Request Fort Frances, ON
P9A 3M3
807.274.3228

Vehicles are exempt from Couchiching Toll Booth Fees under the following circumstances:

1) The passenger vehicle includes a passenger with a Status Card. The Status Card must be made
available and belong to a passenger. This exemption does not apply to commercial vehicles.

! and/or

2) The vehicle has a Couchiching Toll Booth Initiative sticker fixed to the windshield. To apply for an
exemption sticker you must be a Couchiching First Nation Band Member. Sticker exemptions are
available for:
• A Band Memberʼs non-Status spouse or common-law partner
• Non-Status children of Couchiching Band Members

Name of Band Member (Print):__________________________________ Contact # ____________

Vehicle #1

Name on vehicle registration: ________________________________________________________


If registration is not in Band Memberʼs name, check relationship to Band Member: spouse/common law
Make and Model of Vehicle: __________________________________________
License Plate #: ___________________________________________________ child

Vehicle #2

Name on vehicle registration: ________________________________________________________


If registration is not in Band Memberʼs name, check relationship to Band Member: spouse/common law
Make and Model of Vehicle: __________________________________________
License Plate #: ___________________________________________________ child

Vehicle #3

Name on vehicle registration: ________________________________________________________


If registration is not in Band Memberʼs name, check relationship to Band Member: spouse/common law
Make and Model of Vehicle: __________________________________________
License Plate #: ___________________________________________________ child

ALL APPLICATIONS MUST HAVE PHOTOCOPIES OF EACH VEHICLE'S REGISTRATION ATTACHED


- If Band Member has more than 3 vehicles, Band Member may fill out an additional form
- Applicantʼs must notify the Band Office of any changes to the status of exempt vehicles

Signature of applying Band Member ______________________________________

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