Required fields are marked with asterisks (*)

APS Parking Screening Request

parking@stcatharines.ca
905.688.5600
50 Church St, St. Catharines, ON L2R 7C2

Screenings may be conducted in-person or virtually
You will be contacted via email within 3-5 business days with a date and time for your Screening Appointment
Submissions received past 15 days of the Penalty Notice issuance will not be accepted
Screening Appointments cannot be rescheduled or adjourned

All information you provide is protected by the Municipal Freedom of Information and Protection of Privacy Act.

A. Penalty Notice Information

Please provide the information found on the Penalty Notice

Penalty Notice Number:

Penalty Issue Date:

Licence Plate Number:

Location of Offence:

Offence:

B. Registered Vehicle Owner Information

The information provided must match information shown on vehichle ownership

If you are not the registered owner of the vehicle, please ensure Section C is completed below or your request will not be accepted.

Name of Registered Plate Owner:

Phone Number:

Address:

City:

Province:

Postal Code:

Email Address:

C. Authorized Respresentative

If you are not the registered owner of the vehicle, this portion must be completed in order to authorize someone other than the registered owner to dispute on their behalf.

Name of Authorized Representative:

Phone Number:

Address:

City:

Province:

Postal Code:

Email Address:

Declaration:

By submitting this form, I hereby authorize the person named in section C to act and appear for me as my authorized representavtive in the matter pertaining to the Penalty Notice listed above.

The authorized representative named on this form may enter a plea to any offence they deem fit towards completion of this matter as authorized by me in writing.

I am aware that if there is a penalty to be paid after the Screening, the ultimate responsibility to pay the penalty and any administration costs rests with myself.

Signature of Registered Vehicle Owner - ONLY REQUIRED IF SECTION C HAS BEEN COMPLETED

Clear

D. Reason for Appeal

Provide a factual and detailed explanation of the reasons(s) for your screening request

Include vehicle ownership and any other relevant documentation

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

E. Statement of Penalty Notice Recipient

I represent and warrant that:

I am the registered owner of the vehicle identified on the issued Penalty Notice
Upon my authorization of a representative to accompany me and/or act on my behalf in this matter, I acknowledge that if I / they fail to appear and remain at the scheduled Screening until my matter has been determined by a Screening Officer, I will be deemed to have abandoned my request for Screening, the administrative penalty will be affirmed, and I will be liable for an additional $40 fee for having failed to appear.
I have read and understand the conditions of this application

Signature

Clear

Date: