APPLICATION FOR SENIOR CITIZENTAXI CAB PROGRAM

Eligibility
- All participants must reside in Wheeling and be at least 65 years old.
- For proof of residency, applicants must provide a voter registration card, water bill, or similar document.
- For proof of age, applicants must provide a Medicare card, birth certificate, driver’s license, or similar document. An ID card will be issued, provided that proof of residency and age is shown.
PROGRAM

In an effort to assist seniors in meeting their transportation needs, the Village of Wheeling will offer subsidized taxi cab fares to eligible senior citizens who reside in Wheeling.

A.      The discount is $2.00 per one-way trip.

B.      Trips are limited to eight one-way trips or four round trips per month. ***participants can't use more than eight in a month or participants will run the risk of being taken out of the program.

C.      Trips must originate and/or end within the Village of Wheeling.

D.      Operating hours are 24 hours per day.

FIRST NAME *
LAST NAME *
STREET ADDRESS: *
Unit Number
WHEELING, IL 60090
(For proof of residence in the Village of Wheeling, furnish voter registration card, water bill or similar document
PHONE NUMBER:
PHONE NUMBER: *
DATE OF BIRTH: *

Month Day Year
Date
(Applicants must submit proof that he/she is at least 65 years of age Please show birth certificate,driver license, or similar document
Date of Application

Month Day Year
Date
Signature of Applicant *

Clear
Proof of Age *

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Cancel of
Proof of Residency *

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Cancel of
SERIAL NO.
Date Approved :

Month Day Year
Date
Proof of age Proof of residency
BY:
Should be Empty: