Government of Ontario: Ministry of Transportation

Account # U

I (Name of Agent), being the owner of the duly authorized agent of the owners of land or of any equity or rights in or relating to any such land in territory where there is no Municipal Organization in the District of , Province of Ontario, hereby make application to the Honourable The Minister, for aid under The Public Transportation and Highway Improvement Act, in the construction, improvement, maintenance or repair of the road situated in the said territory and described as follows:

Township            Number of km
Description

The work to be done shall consist of:

At an estimated cost of $

I attach a marked cheque payable to the Minister of Finance in the amount of $ being fifty per centum of the estimated cost of the said work. Please record Account # U on the submitted cheque.

It is understood and agreed that the Ministry will expend on the said work a sum not exceeding the estimated cost and that any additional expenditure required shall be borne and paid by me.

It is further understood and agreed that if the amount actually expended on the work by the Ministry is less than the estimated cost, the Ministry will refund to me fifty per centum of the difference.

Mailing Address
Date (yyyy/mm/dd)          Telephone Number
Manager of Operational Services