Required fields are marked with asterisks (*)

Screening Review Request

Administrative Monetary Penalty System

Every person who is issued a Penalty Notice has the right to dispute the Penalty Notice by requesting a Screening Review within 15 days of the issuance of the Penalty Notice. Written notice of your Screening Review 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

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

Keep in Touch