Alberta Pardons Printable Application

Printable Application

Directions:

1) Enter the required information (*) or print the application and fill it in by hand.

2) Print a copy of the completed application (keep one for your records).

3) Fax the application to: 780-665-7371, mail it in with your cheque or money order, or bring it to your appointment.

________________________________________________________________________________________________

* Full Name

* Other Names

(your Full Legal Currently Used Name)

(maiden name, previous married name(s), legal name changes, documented nick names, names stated to authorities)

* Mailing Address

Physical Address (needed if mailing address is different or is a PO Box #)

* City

* Province

* Postal Code

* How long have you lived at this address?

(month & year you moved in)

* Home Phone

Cell Phone

* Work Phone

* Present Employer

I am Self-Employed. I need to enter the U.S. for business.
(Kept Confidential)

* Private Email (No Hotmail Please) Get Free Gmail

* 1st Preferred Method of Contact: * 2nd Preferred Method:
* Are members of your household aware of this application?
Yes

No

Married/Common Law

Single

(i.e. March 14, 1970)

* Date of Birth

* Male
Female

* Place of Birth

* Driver's Lic. # and Province (i.e. 55-555-555 Alberta)

* Citizenship (you must be a Canadian Citizen to get a U.S. Waiver through our office, and the same goes for Indictable Offense Pardons)

* Please write all the Additional Addresses of where you have lived in the last 5 or 10 years in the boxes below. If you are applying for a Pardon it's 10 years, and there will be an additional $63.00 charge to cover Local Police Record Searches for each additional city/town you have lived in, within the last 5 years. Additional charges will not apply if the same police force serves each location. For Waiver applications it's 5 years and there are no additional charges.

1. , From: (MM YY) To: (MM YY) * ( PO Box Numbers are not accepted by the PBC )

2. , From: (MM YY) To: (MM YY) ( Postal Codes are NOT required )
3. , From: (MM YY) To: (MM YY)

4. , From: (MM YY) To: (MM YY)

5. , From: (MM YY) To: (MM YY)

6. , From: (MM YY) To: (MM YY)

7. , From: (MM YY) To: (MM YY)

* Service(s) Required:

Standard Canadian Pardon (removes your criminal record from CPIC): $495.00 plus disbursements + GST = $645.75. Fee includes 1 Court Record Search and 1 Local Police Records Check ($60.00 X 2 + GST = $126.00). Note: When your application is ready to be submitted you will be required to pay the Parole Board Filing Fee, which is now $631.00 (as of February 23, 2012). For more information please see our Prices page. Note: Does not include $71.50 fingerprinting fee) Note: Additional fees will be incurred if you have multiple offences where fines were imposed, or if you have served in the Canadian Military, or if you have lived in more than 1 city within the last 5 years. Additional Court Record, Local Police Record and Military Record Searches are $63.00 including GST.

US Entry Waiver: $519.75. (Includes 1 Court Record Search. Does not include $71.50 fingerprinting fee) Note: When your application is ready to be submitted you will be required to pay a $585.00 (USD) United States Department of State filing fee (as of November 23, 2010). For more information please see our Prices page. Note: If you have a Sexual Assault conviction we may also need to do 1 or 2 Privacy Act Information Requests for $252.00 each. For more information please see our Prices page.

Standard Canadian Pardon and U.S. Entry Waiver: Standard Total = $1165.50 (Includes 2 Court Record Searches and 1 Local Police Records Check. Does not include $143.00 fingerprinting fee or the $631.00 Parole Board Filing Fee.)

* PBC Priority Pardon Service: $126.00 *NOTE: We prioritize all applications at no extra cost, however, the PBC will prioritize Pardon applications in some cases. For more information please see FAQ Pardons Page, # 5.

Additional Court, Police or Military Record Searches: $63.00 For each record.
For more information please see our Prices page.
Pardoned Record and/or Court Record Search only: $126.00 For more information please see our Prices page.

Port of Entry Parole (for emergency travel into the U.S.): $252.00 Note: This permit is for clients who are applying for a Standard US Entry Waiver, and who need to enter the United States for emergency life-saving medical treatment or to attend a funeral for an immediate family member ONLY. Please call our office or see our Waiver FAQ section (10 & 14) if you are unsure if you are eligible to receive such a permit.

Police File Destruction Services: $252.00 (For more information please see our Prices page or our Pardon FAQ's)

Privacy Act Information Request: $252.00. For more information please see our Prices page.

Additional or Other Administration Fees: $63.00 per hour. For more information please see our Prices page.

US Entry Waiver Renewal (only for past Alberta Pardons clients) $467.25.

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* Credit Card Information (we also accept cash, cheques, money orders or debit cards)

MasterCard or Visa Number

Expiry Date / MM/YY

Name on Card Note: Your credit card will show "ALBERTAPARD-ABFPS"

Please bill in 2 or 4 monthly installments. Please Note: Your credit card will be billed in 2 monthly installments for Pardons or Waivers, and 4 installments for both.

* Have you ever served in the Military?

Yes (For Pardons there is a $63.00 charge to cover Military Record Search fees) Note: In the Comments Section below please provide your Military ID Number, Service Dates, Address of Unit, and the Name of your Commander.

* Have you received a Pardon in the past?

Yes

* Have you ever applied for a U.S. Entry Waiver in the past?

Yes (If YES enter your A-Number, Date & Location Filed or Date and Time Period Granted)

* Have you ever been questioned by U.S. Customs about your criminal record, or denied entry into the U.S. because of your record?

Yes (If YES when & where were you questioned & were you denied entry at that time) I was denied entry.

* Do you have a Passport? (Note: Since August of 2008 Passports have been encoded with an FPS (FingerPrint Service) number if you have a criminal record on CPIC at the time your Passport is processed.)

Yes (Year obtained or renewed)

* When were you charged or convicted of the offense(s)?

How did you hear about Alberta Pardons?

Comments: (Please include your convictions [if known] and the locations [city or town] of where you were sentenced)

Please print this form and then mail, fax or bring it in. (Click on "File" then "Print")

Alberta Pardons
Office Address: 205, 12907 - 97 Street, Edmonton, AB.

Mailing Address
P.O. Box 71111
Edmonton, AB.
T5E 6J8

Fax: 780-665-7371
Ph: 780-473-7171

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