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
*
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.