Application for Free R-Route Pass
Free passes are available to residents in low and moderate income areas of Hamilton through the generosity of Hamilton’s CDBG. Please visit www.butlercountyrta.com to see if you are in one of these areas. All questions must be answered before your application will be considered. To be completed by applicant or on behalf of the applicant.
First Name *
Last Name *
Middle Initial
Date of Birth *
Last four (4) digits of your Social Security Number. *
Street Address *
Apartment Number
City *
State *
Zip Code *
E-mail Address *
Phone number where you can be reached. *
Please provide a copy of your photo I.D. If the address on your photo I.D. does not match the address you have provided you must submit another form of identification that proves residency. (utility bill, phone bill, any sort of mail that has the same address you provided)
Please provide a photo copy of your I.D. along with any other documentation that is needed to prove residency. *
Required
Applicants Signature *
I understand that if my application for a free pass is excepted that I must use it for personal use only. I agree not to resell it or use it in any other manner than for my personal use. I also understand that any fraudulent use of the pass will be subject to prosecution. *
Required
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