Required fields are marked with asterisks (*)

Parking Pass Taxable Benefit Annual Acknowledgment

City records indicate you hold a parking permit for access to a municipal parking lot in downtown Guelph or you have requested a City-paid parking permit.

The Canadian Revenue Agency (CRA) has determined that the City of Guelph is required to levy a parking taxable benefit to all staff who receive a City-paid parking benefit. The taxable benefit is 55% of the Fair Market Value (FMV) of what a non-City of Guelph employee would pay for the cost of the parking permit (the FMV values are available at www.guelph.ca/parking -> Downtown Parking and are subject to change). You do not pay this taxable benefit amount, but income tax is calculated (approximately 30% of the taxable benefit amount) and remitted to the CRA on your behalf.

Please complete the fields below and be prepared to provide supporting documentation to the City of Guelph and/or to the CRA, as appropriate and upon request. If there is a change to your situation that would alter any of your answers to these questions, please notify Parking as soon as possible to ensure you are not over- or under-charged for this taxable benefit.

Retroactive reimbursements to your taxable benefit amount will not be made due to a failure to notify Parking of a change in your situation.

Employee Name (First and last name format)

Employee ID #

Tax Year

Municipal Parking Lot Permit Location

Do you need to use a vehicle to commute to work because of a physical disability that limits your mobility?

Yes

Are you required to use your car for business purposes, on an annual basis, three (3) or more times per week? (business purposes do not include commuting to/from work)

Yes

I acknowledge that I have read the information provided in this document and the answers to the two (2) Yes or No questions above are accurate to the best of my knowledge and that I may incur a parking taxable benefit based on the answers I have provided:

Furthermore, I acknowledge that I will be required to complete and submit this form annually as long as I am in possession of a free parking pass provided by the City of Guelph:

Lastly, I acknowledge that this form should be updated any time there are changes to my parking situation and that no retroactive reimbursements will be made should I fail to promptly notify Parking of any changes to my parking/driving situation:

Collection of personal information

Personal information is being collected and will be used for the purpose of determining the parking pass taxable benefit, if any, for an employee who has been provided a free parking pass at a municipal lot.

Personal information, as defined by Section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001, and in accordance with the provisions of MFIPPA.

If you have questions about the collection, use or disclosure of this personal information please contact the City’s Information and Access Coordinator at 519-822-1260 extension 2349 or email privacy@guelph.ca.