Required fields are marked with asterisks (*)

Hearing Appeal Request

Administrative Monetary Penalty System

If a person wishes to dispute the screening decision, a person may request a Hearing Appeal no later than 15 days after the date of service of the Screening Decision. Written notice of your Hearing Appeal appointment will be provided.

All meetings will be held virtually via zoom, if you require accommodation, you should inform the Township as soon as possible. Please advise the Township of your accommodation needs so that appropriate arrangements can be made prior to your appointment.

SECTION 1 - PENALTY NOTICE INFORMATION

Penalty Notice Number (Red number at top right of ticket)

Offence Date (mm/dd/yyyy)

Location of Offence

Screening Review Date

I affirm that I was present at the scheduled screening review and, given the outcome, I intend to advance my appeal to the level of a Hearing Officer

YES

SECTION 2 - DEFENDANT INFORMATION

First and Last Name

Phone Number

Email Address

Mailing Address

City

Province/State

Postal/Zip Code

Country

Will you be representing yourself for this matter? (*If no, you will be directed to a different page to fill out an Authorization to Act as Agent Form)

Yes

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