Request an Extension of Time to Request a Hearing

Plate / VIN (If your Penalty Notice is WHITE please N/A)(Required)

Penalty Notice #(Required)

Date of Screening Decision(Required)

Name(Required)

First Last

Email(Required)

Phone

Are you the registered owner of the vehicle or have their permission to submit on their behalf?(Required)

Yes

No - The owner of the vehicle or a person with authority of the owner is required for the Town to review the request.

Not applicable (select this option if the offence is not related to parking)

Please provide in detail the reason(s) why you need to apply for an extension of time to request a Hearing

If needed, please provide any documents needed to explain or validate your request for the extension of time for a Hearing. (maximum of 2)

Drop files here or

Max. file size: 10 MB, Max. files: 2.

Collection of Personal Information

Collection of Personal Information Personal information contained on this form is collected pursuant to the Municipal Act, 2001, s. 11(1), and will be used for the purpose of "Requesting a Hearing". Questions about this collection should be directed to the Records & Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9 or 905-683-4550 Accessibility This form is available in alternate formats, upon request, by contacting 905-683-4550, or email accessibility@ajax.ca