Request for Screening Review

If you are not in agreement with the Penalty Notice you have recieved, you may request a Screening by filling out the form below.

Ticket Information

Ticket Number	*
Plate Number	*

Registered Owner Information

Name	*
E-Mail	*
Phone	*
Address, City, Postal Code	*

I acknowledge that the Town of Innisfils Screening Officer will rely on the information provided in this form to confirm vehicle ownership.

Check if The Applicant Information is different from the Owner Information above

IMPORTANT if you are not the registered owner of the vehicle, please complete the Authorization to Act Form. The registered owner must authorize you to request a review of the penalty notice.

Applicant Information

If you are not the owner of the vehicle, a screening request will only be processed if you have submitted an authorization to act as agent form (Upload the completed and signed form below).

Name	*
E-Mail	*
Phone	*
Address, City, Postal Code	*
Upload of Authorization Form	*

Violation and screening Information

Reason for Requesting Screening*

Upload a related picture (optional)

Please acknowledge that you understand all screenings will be in English, and if you require an interpreter, you are responsible for providing your own. I am comfortable speaking English. I will be bringing an interpreter.

By checking this checkbox, I certify that all information provided in this application is true and accurate.

The Municipal Freedom of Information and Protection of Privacy Act applies to all information collected by the Town through this application. The information will only be collected, used and disclosed in accordance with the Act. Questions about this collection can be directed to the Clerks Office, Town of Innisfil, 2101 Innisfil Beach Road, Innisfil ON, L9S 1A1. Telephone: 705-436-3710.