Government of Yukon

Community Services

A to Z forms

 Builders Lien Act

 Form 1 - Claim of Lien for Materials or Machinery Placed or Furnished
         Bilingual PDF (YG6237)

 Form 2A - Claim of Lien for Wages for Work Done (Single Claimant)
         Bilingual PDF (YG6238)

 Form 2B - Claim of Lien for Wages for Work Done (Multiple Claimants)
         Bilingual PDF (YG6239)

 Form 3 - Receipt for Discharge of Lien
         Bilingual PDF (YG6240)

 Form 4 - Affidavit Verifying Claim of Lien or Discharge
         Bilingual PDF (YG6241)


 Building Safety 

 Affidavit of Manufacturer for Cast Iron Boilers or Pressure Vessels
         English PDF (YG5399)

 Building Permit - Application
         Bilingual PDF (YG5981)

 Confirmation of Assurance of Professional Design and Commitment for Field Review
         English PDF (yg5734)

 Development Permit - Application
         Bilingual PDF (YG5982)

 Electrical Contractor Declaration Form
         Bilingual PDF (YG4059)

 Electrical Permit - Application
         Bilingual PDF (YG5401)

 Elevating Devices - Application for Contractor's Licence
         Bilingual PDF (YG5406)

 Elevating Devices - Application Renewal of Contractor's Licence
         Bilingual PDF (YG5403)

 Elevator Inspections - Registration Information (Confidential)
         English PDF (YG5426)

 Gas Permit - Application
         Bilingual PDF (YG4271)

 Installers Declaration - Elevators, Escalators, Dumbwaiters, Moving Walks, Freight Platform Lifts
         Bilingual PDF (YG5405)

 Installers Declaration - Handicap Lifts, Manlifts, Passenger Ropeways, Amusement Rides, Personnel Hoists
         Bilingual PDF (YG5407)

 Plumbing Permit - Application
         Bilingual PDF (YG5983)

 Pressure Welder's Certificate of Qualification - Application
         Bilingual PDF (YG5402)


 Business Corporation Act 

 Form 1 - Articles of Incorporation
         Bilingual PDF (YG6119)

 Form 2 - Notice of Address of Corporation
         Bilingual PDF (YG6120)

 Form 3 - Notice of Change or Address of Corporation
         Bilingual PDF (YG6121)

 Form 4 - Notice of Change of Address of Corporation (by person who maintains registered or records office)
         Bilingual PDF (YG6122)

 Form 5 - Notice of Resignation of Person who Maintains Registered or Records Office
         Bilingual PDF (YG6123)

 Form 7 - Articles of Amendment
         Bilingual PDF (YG6124)

 Form 8 - Notice of Directors
         Bilingual PDF (YG6125)

 Form 9 - Notice of Change of Directors and Directors’ Addresses
         Bilingual PDF (YG6126)

 Form 10 - Notice of Change of Shareholders and Shareholders’ Addresses
         Bilingual PDF (YG6127)

 Form 11 - Restated Articles of Incorporation
         Bilingual PDF (YG6128)

 Form 12 - Articles of Amalgamation
         Bilingual PDF (YG6129)

 Form 13 - Application for Authorization to Amalgamate with Extra-Territorial Body Corporate into Another Jurisdiction
         Bilingual PDF (YG6130)

 Form 14 - Articles of Continuance
         Bilingual PDF (YG6131)

 Form 15 - Application for Authorization to Continue into Another Jurisdiction
         Bilingual PDF (YG6132)

 Form 16 - Articles of Reorganization
         Bilingual PDF (YG6133)

 Form 17 - Articles of Arrangement
         Bilingual PDF (YG6134)

 Form 18 - Articles of Revival
         Bilingual PDF (YG6135)

 Form 19 - Articles of Dissolution (special case)
         Bilingual PDF (YG6136)

 Form 20 - Statement of Intent to Dissolve (unsupervised liquidation)
         Bilingual PDF (YG6137)

 Form 22 - Statement of Revocation of Intent to Dissolve
         Bilingual PDF (YG6138)

 Form 23 - Articles of Dissolution (after unsupervised liquidation)
         Bilingual PDF (YG6139)

 Form 25 - Annual Return of Yukon Corporation
         Bilingual PDF (YG6140)

 Form 26 - Statement for Registration as an Extra-Territorial Corporation
         Bilingual PDF (YG6141)

 Form 27 - Appointment of Attorney for Service and Alternative Attorney of Extra-Territorial Corporation
         Bilingual PDF (YG6142)

 Form 28 - Application for Cancellation of Assumed Name of Extra-Territorial Corporation
         Bilingual PDF (YG6143)

 Form 31 - Notice of Change of Address for Attorney For Service of Extra-Territorial Corporation
         Bilingual PDF (YG6144)

 Form 32 - Notice of Change of Statement for Registration as an Extra-Territorial Corporation
         Bilingual PDF (YG6145)

 Form 33 - Notice of Change of Directors and Directors Addresses
         Bilingual PDF (YG6146)

 Form 35 - Statement of Amalgamation of Extra-Territorial Corporation Effected in Another Jurisdiction
         Bilingual PDF (YG6147)

 Form 36 - Annual Return of Extra-Territorial Corporation
         Bilingual PDF (YG6148)

 Form 37 - Statement for Registration as an Extra-Territorial LLC
         Bilingual PDF (YG6149)

 Form 38 - Appointment of Attorney for Service and Alternative Attorney of Extra-Territorial LLC
         Bilingual PDF (YG6150)

 Form 39 - Application for Cancellation of Assumed Name of Extra-Territorial LLC
         Bilingual PDF (YG6151)

 Form 42 - Notice of Change of Addresses of Attorney for Service of Extra-Territorial LLC
         Bilingual PDF (YG6152)

 Form 43 - Notice of Change to Statement for Registration as an Extra-Territorial LLC
         Bilingual PDF (YG6153)

 Form 44 - Notice of Change of Managers and Managers Addresses (extra-territorial LLC)
         Bilingual PDF (YG6154)

 Form 46 - Statement of Amalgamation of Extra-Territorial LLC Effected in Another Jurisdiction
         Bilingual PDF (YG6155)

 Form 47 - Annual Return of Extra-Territorial LLC
         Bilingual PDF (YG6156)


 Chiropractor Act 

 Licence Application - Chiropractor
         English French PDF (YG5090)

 Licence Renewal - Chiropractor
         English French PDF (YG5126)


 Consumer Protection Act 

 Collection Agency Employee - Renewal
         English French PDF (YG5310)

 Application for Collection Agency
         Bilingual PDF (YG5094)

 Application for Collection Agency Employee
         Bilingual PDF (YG5093)

 Collection Agency - Renewal
         English French PDF (YG5125)


 Dental Professions Act 

 Dentist - General or Specialist - Licence Application
         English French PDF (YG5097)

 Dental Hygienist or Therapist - Licence Application
         English French PDF (YG5095)

 Dentist - General or Specialist - Licence Renewal
         English French PDF (YG5056)

 Dental Hygienist or Therapist - Licence Renewal
         English French PDF (YG5058)


 Denturist Act

 Denturist - Licence Renewal
         English French PDF (YG5059)

 Denturist - Licence Application
         English French PDF (YG5098)


 Election 

 Advance Poll Oath
         Bilingual PDF (YG3633)

 Affidavit of Printer
         Bilingual PDF (YG3630)

 Application for Registration
         Bilingual PDF (YG3628)

 Appointment of Election Officer
         Bilingual PDF (YG3632)

 Authorization of Agent
         Bilingual PDF (YG3634)

 Ballot Account
         Bilingual PDF (YG4443)

 List of Electors
         Bilingual PDF (YG3624)

 Nomination Paper
         Bilingual PDF (YG3626)

 Notice of Application for Revision
         Bilingual PDF (YG4441)

 Notice of Hearing
         Bilingual PDF (YG3622)

 Notice of Nominations
         Bilingual PDF (YG3623)

 Notice of Poll
         Bilingual PDF (YG3621)

 Oath of Allegiance
         Bilingual PDF (YG5197)

 Oath of a Challenged Elector
         Bilingual PDF (YG3629)

 Oath of Elector's Assistant
         Bilingual PDF (YG4867)

 Oath of a Member of the Board of Revision
         Bilingual PDF (YG3627)

 Oath of Office
         Bilingual PDF (YG5196)

 Oath of Witness
         Bilingual PDF (YG4440)

 Poll Book
         Bilingual PDF (YG3635)

 Preliminary List of Electors
         Bilingual PDF (YG3625)

 Revised List of Electors Certificate of Board of Revision
         Bilingual PDF (YG3631)

 Special Ballot Application and Oath
         Bilingual PDF (YG4868)

 Tally Sheet
         Bilingual PDF (YG4442)


 Ember Fire Academy

 Application - Ember Fire Academy
         Bilingual PDF (YG6553)


 Employment Standards 

 Complaint Information Form
         English French PDF (YG5600)

 Complaint Information Form Tip Sheet
         English French PDF (Guidelines)


 Funeral Directors Act 

 Funeral Director - Licence Application
         French English PDF (YG5089)

 Funeral Director - Licence Renewal
         French English PDF (YG5127)


 Garage Keepers Lien Act


 Gas Tax Fund

 Final Reporting
         English French PDF (YG6600)

 Gas Tax Project Proposal
         English French PDF (YG6008)

 Progress Claim - Cash Flow
         English French PDF (YG6601)

 Progress Claim - Financial Reporting
         English French PDF (YG6602)


 Insurance Act 

 Adjuster - Application
         Bilingual PDF (YG5318)

 Agent - Application
         Bilingual PDF (YG5084)

 Broker - Application
         Bilingual PDF (YG5190)

 Broker - Licence Renewal
         French English PDF (YG5322)

 Insurance Adjuster - Licence Renewal
         English PDF (YG5134)

 Insurance Agent - Licence Renewal
         French English PDF (YG5130)

 Insurance Fee Schedule
         Bilingual PDF (YG5088)

 Insurance Salesperson - Licence Renewal
         English PDF (YG5129)

 Insurer's Licence - Application
         English French PDF (Canadian Council of Insurance Regulators)

 Insurer's Licence - Renewal
         English French PDF (YG5117)

 Insurer's Recommendation of Agent
         English French PDF (YG6481)

 Salesperson - Application
         Bilingual PDF (YG5123)

 Special Broker - Application
         Bilingual PDF (YG5120)

 Special Broker - Licence Renewal
         English PDF (YG6767)

 Special Broker - Monthly Return
         Bilingual PDF (YG5121)


 Licensed Practical Nurses

 Application - Courtesy Licence - LPNs
         English French PDF (YG6647)

 Application - Full Licence - LPNs
         English French PDF (YG6644)

 Application - Inactive Licence - LPN
         English French PDF (YG6101)

 Application - Interim Licence - LPNs
         English French PDF (YG6645)

 Application - Reinstatement of Licence - LPNs
         English French PDF (YG6649)

 Application - Renewal of Licence - LPNs
         English French PDF (YG5146)

 Verification of Registration in another Canadian Jurisdiction
         French English PDF (YG6656)


 Lottery Licencing Act 

 Accountant Option Declaration
         English French PDF (YG5731)

 Bingo - Control Sheets (Sample)
         English French PDF (YG5714)

 Bingo - Financial Report
         English French PDF (YG5338)

 Bingo Licence - Application
         English French PDF (YG5091)

 Casino Games - Application
         Bilingual PDF (YG5092)

 Casino Games - Financial Report
         English French PDF (YG5340)

 Chase the Ace-Style Lottery - Application Package
         English French PDF (YG6588)

 Chase the Ace-Style Lottery - Financial Report
         English French PDF (YG6641)

 Chase the Ace-Style Lottery - Tracking Sheet
         English French PDF (YG6613)

 Eligibility Questionnaire - Gaming Licence
         English French PDF (YG6606)

 Raffle - Financial Report
         English French PDF (YG5339)

 Raffle Licence - Application
         English French PDF (YG5101)

 Raffle - Terms and Conditions - Single Day
         English French PDF (YG5730)

 Raffle - Ticket Inventory Control Worksheet
         English French PDF (YG5759)

 Raffle - Ticket Format (Sample)
         English French PDF (N/A)

 Prize Guarantee by Financial Institution
         English French PDF (YG5713)

 Prize Guarantee by Individual
         English French PDF (YG5712)

 Statutory Declaration - Meals
         English French PDF (YG5715)

 Travel Itinerary, Request for
         English French PDF (YG5103)


 Marriage Act 

 List of Clergymen Authorized to Solemnize Marriage
         Bilingual PDF (YG5055)


 Medical Profession Act 


 Naming Regulation

 Form 1 - Application for Name Reservation
         Bilingual PDF (YG6212)


 Optometrists Act 

 Optometrist - Licence Application
         English PDF (YG5308)

 Optometrist - Licence Renewal
         French English PDF (YG5192)


 Partnership and Business Names Act 

 Form 1 - Notice of Office of Limited Partnership
         Bilingual PDF (YG6189)

 Form 2 - Notice of Change of Registered Office of Limited Partnership
         Bilingual PDF (YG6190)

 Form 3 - Application for Registration of Limited Partnership Formed Outside Yukon
         Bilingual PDF (YG6191)

 Form 4 - Declaration of Partnership
         Bilingual PDF (YG6192)

 Form 5 - Renewal of Declaration of Partnership
         Bilingual PDF (YG6193)

 Form 6 - Notice of Change of Information in Declaration of Partnership
         Bilingual PDF (YG6194)

 Form 7 - Declaration of Dissolution of Partnership
         Bilingual PDF (YG6195)

 Form 8 - Declaration of Business Name
         Bilingual PDF (YG6196)

 Form 9 - Notice of Change of Information in Declaration of Business Name
         Bilingual PDF (YG6197)

 Form 10 - Renewal of Declaration of Business Name
         Bilingual PDF (YG6198)

 Form 11 - Declaration of Cessation of Use of Business Name
         Bilingual PDF (YG6199)

 Form 12 - Application for Registration as an LLP
         Bilingual PDF (YG6200)

 Form 14 - Notice of Change of Information in Application for Registration as LLP
         Bilingual PDF (YG6201)

 Form 15 - Renewal of Registration as LLP
         Bilingual PDF (YG6202)

 Form 16 - Request to Cancel Status as LLP
         Bilingual PDF (YG6203)

 Form 17 - Statement from Governing Body of a Prescribed Profession
         Bilingual PDF (YG6204)

 Form 18 - Annual Report Limited Partnership Formed In Yukon
         Bilingual PDF (YG6205)

 Form 19 - Annual Report Limited Partnership Formed Outside Yukon
         Bilingual PDF (YG6206)


 Pawnbrokers and Secondhand Dealers Act 

 Licence Application and Renewal - Pawnbroker, Second-hand Dealer
         English French PDF (YG5135)


 Pharmacists Act 

 Pharamcist and Rural Permit - Renewal
         English French PDF (YG6701)

 Application for Pharmacists
         Bilingual PDF (YG5061)


 Physiotherapist Act

 Courtesy Certificate - Physiotherapist
         English French PDF (YG6689)

 Full Certificate - Physiotherapist
         English French PDF (YG6685)

 Inactive Certificate - Physiotherapist
         English French PDF (YG6686)

 Interim Certificate - Physiotherapist
         English French PDF (YG6687)

 Licence Renewal - Physiotherapist
         English French PDF (YG6668)

 Reinstatement Application - Physiotherapist
         English French PDF (YG6688)

 Special Endorsement - Physiotherapist
         French English PDF (YG6658)


 Private Investigators and Security Guards Act 

 PISG Agent - Renewal
         French English PDF (YG5124)

 PISG Agency - Renewal
         English French PDF (YG5390)

 Security Agency - Licence Application
         English PDF (YG5141)

 Security Professional - Licence Application
         English PDF (YG5391)


 Professional Licensing & Regulatory Affairs 

 Annual Continuing Education
         English French PDF (YG6519)

 Verification of Completed Continuing Education
         English French PDF (YG6648)

 Verification of Volunteer Hours
         English French PDF (YG6646)

 Continuing Competency Exemption
         English French PDF (YG6657)

 Verification of Employment - Health Professions
         English French PDF (YG6520)

 Verification of Employment - Business Professions
         English French PDF (YG6699)

 Verification of Self-Employment
         English French PDF (YG6700)

 Payment Information
         English French PDF (YG5924)

 Professional Corporation - Request for Confirmation of Eligibility
         English PDF (YG6755)

 Professional Corporation - Renewal
         English PDF (YG5057)

 Professional Corporation - Application
         English PDF (5100)


 Professional Licensing and Regulatory Affairs (PLRA)


 Property Assessment and Taxation

 Home Owner's Grant - Application
         Bilingual PDF (YG3101)


 Real Estate Agents Act 

 Application for Real Estate Salesperson
         Bilingual PDF (YG5368)

 Renewal Application for Agent Real Estate
         Bilingual PDF (YG5137)

 Renewal for Salesperson Real Estate
         Bilingual PDF (YG5194)


 Recycling

 Beverage Container Depot - Application to Operate
         English French PDF (YG4163)

 Beverage Container Regulation - Application for Registration
         English French PDF (YG6319)

 Beverage Container Regulation - Daily Cash Count Sheet
         English French PDF (YG4245)

 Beverage Container Regulation - Dealer's Monthly Return
         English French PDF (YG4159)

 Designated Materials Regulation - Retailer's Quarterly Tire Return
         Bilingual PDF (YG5151)

 Water Delivery Request
         Bilingual PDF (YG6260)


 Registered Psychiatric Nurse (RPN)

 Courtesy Certificate - RPN
         English French PDF (YG6681)

 Full Certificate Application - RPN
         English French PDF (YG6680)

 Inactive Certificate - RPN
         English French PDF (YG6682)

 Interim Certificate - RPN
         English French PDF (YG6683)

 Licence Renewal - RPN
         English French PDF (YG6667)

 Reinstatement Application - RPN
         English French PDF (YG6684)


 Residential Landlord and Tenant Act

 1-Month Notice to End Tenancy From Tenant to Landlord for a Monthly Tenancy
         English French PDF (YG6033)

 2-Month Notice to End Tenancy From Landlord to Tenant for a Monthly Tenancy
         English French PDF (YG6034)

 3- Month Notice to End Tenancy for Yearly Tenancy
         English French PDF (YG6035)

 14 Day Notice to End Tenancy
         English French PDF (YG6036)

 Application for Dispute Resolution
         English French PDF (YG6031)

 Condition Inspection Report
         English French PDF (YG6032)

 Declaration of Service - Landlord Serving Tenant
         English French PDF (YG6039)

 Declaration of Service - Tenant Serving Landlord
         English French PDF (YG6038)

 Fee Waiver Application
         English French PDF (YG6040)

 Tenancy Agreement
         English French PDF (YG6037)


 Society Act 

 Form 1 - Application for Incorporation of a Society
         Bilingual PDF (YG6164)

 Form 2 - Notice of Change of Directors and Officers
         Bilingual PDF (YG6165)

 Form 3 - Declaration of Category C Society
         Bilingual PDF (YG6166)

 Form 4 - Notice of Change of Address and/or Place Where Operations are Carried
         Bilingual PDF (YG6167)

 Form 5 - Notice of Fiscal Year-end of Society
         Bilingual PDF (YG6168)

 Form 6 - Annual Report of Yukon Society
         Bilingual PDF (YG6213)

 Form 9 - Articles of Revival
         Bilingual PDF (YG6169)

 Form 11 - Statement for Registration as an Extra-Territorial Society
         Bilingual PDF (YG6170)

 Form 12 - Appointment of Attorney for Service of Extra-Territorial Society
         Bilingual PDF (YG6171)

 Form 13 - Application for Cancellation of Assumed Name of Extra-Territorial Society
         Bilingual PDF (YG6172)

 Form 15 - Notice of Change of Address of Attorney for Service of an Extra-Territorial Society
         Bilingual PDF (YG6173)

 Form 16 - Annual Report of Extra-Territorial Society
         Bilingual PDF (YG6214)

 Form 18 - Declaration of Category C Extra-Territorial Society
         Bilingual PDF (YG6174)

 Form 19 - Notice of Fiscal Year-end of an Extra-Territorial Society
         Bilingual PDF (YG6175)


 Sports and Recreation

 Elite Athlete Grant – Athlete Report
         English French PDF (YG6050)

 High Performance Grant - Athlete Report
         English French PDF (YG6046)

 High Performance Grant - Officials Report
         English French PDF (YG6049)

 In‐Territory Travel Claim Form
         English French PDF (YG6542)

 Small Capital Projects Fund - Application
         English French PDF (YG6574)

 YRAC and YS4L - Affiliate Verification Form
         English French PDF (YG6103)

 YRAC and YS4L - Profile Information Form
         English French PDF (YG6051)

 YRAC Grant - Special Recreation Groups - Accountability Reporting Form
         English French PDF (YG6058)

 YRAC Grant - Special Recreation Groups - Application
         English French PDF (YG6060)

 YRAC Grant - Project Report
         English French PDF (YG6054)

 YRAC Grant - Sport Groups - Application
         English French PDF (YG6052)

 YS4L Grant - Project Report
         English French PDF (YG6061)

 YS4L Grant Application
         English French PDF (YG6063)

 Yukon High Performance - Athlete Assistance Program
         English French PDF (YG6043)

 Yukon High Performance - Officials Program
         English French PDF (YG6047)


 Wildland Fire Management

 FireSmart Project Application
         English French PDF (YG6643)


 Yukon Public Libraries 

 Yukon Public Libraries Request
         Bilingual PDF (YG3264)