Record Suspension & USA Entry Waiver Application

Please answer ALL required * questions and submit the form back to our office by clicking the SUBMIT button below

Full Name*

FirstMiddle(s)Last

Other Names Used Since Birth

Date of Birth*

Address*

Street Address

Physical Address (provide if mailing address is different or is a PO Box

CityProvince / State

Postal / Zip Code

How Long Have you Lived at This Address*

Phone Number*

Area CodePhone Number

Email*

Present Employer

Preferred Method of Contact

Phone NumberEmail Address

Are Members of Your Household Aware of Your Application*

YESNO

Marital Status

SingleMarried / Common LawSeparated

Place of Birth*

Drivers License / Provincial ID Card #

Citizenship*

Previous Addresses for the Past 10 Years (if Your Current Address is Less Than 10 Years)

	Address	From	To
1
2
3
4

*Service(s) Required:

Record Suspension: $1195.00 includes RCMP Fingerprints, 1 Court Search, 1 Local Police Check, and Gov't Submission Fee. Note: Additional Court Search and Local Police checks may be required at additional cost.USA Entry Waiver: $1044.00 includes RCMP fingerprints, 1 Court Search, and Supporting Documents. Note: Additional Court Search may be required at additional cost.Record Suspension & USA Entry Waiver.Police File Destruction: $1195.00 includes RCMP Fingerprints, , 1 Court Search, 1 Local Police Check, and Submission Fee. Note: Additional Court Fees may be required at additional cost.Court Search Only: $275.00 includes 1 Court Search.In Person Consultation: $125.00 per 1/2 hour for inquires and appointments.

Payment Information

Please Bill card in 2 or 3 equal payments

Yes: (2 equal payments)Yes: (3 equal Payments)

Have You Served in the Canadian Military (Past or Present)*

YESNO

Have You Received a Canadian Record Suspension (Pardon) in the Past

YesNo

Have You Ever Applied for a USA Entry Waiver in the Past

YesNo

Have You Ever Been Questioned by US Customs About Your Criminal Record, or Denied into the USA because of Your Record

YesNo

Do You Have a Canadian Passport

YesNo

When Were You Convicted of Your Latest Offense(s)

Do You Have Any Assault CBH or Assault with a Weapon Convictions

YesNo

Do You Have Any Sexual Assault Convictions

YesNo

Please include your convictions (if known) and the location (City or Town) where you were sentanced in the Additional Comments section

Additional Comments

Office Address:
Alberta Pardons
#7, 9363 - 50 St. NW Edmonton, AB. T6B 2L5
Ph: 780-473-7171

Alberta Pardons Application