Required fields are marked with asterisks (*)

Request for Extension of Time to Request a Screening Review

The Town of LaSalle issues penalty notices (parking and by-law tickets) for various infractions under the Administrative Monetary Penalties System (AMPS).

If you have received a Penalty Notice (parking or by-law ticket), and have a valid reason for missing the deadline to submit a Request for a Screening Review (insert live link), you may use this form to request an extension per Section 6.2 of By-law 8289.

The Request for Extension of Time to Request a Screening Review must be filed within thirty (30) days of the Penalty Notice Date. Requests for Extension received on the 31st day or later, will not be considered and the following provisions apply to the Penalty Notice (also known as the "Administrative Penalty") per Section 6.3 of By-law 8289:

You shall be deemed to have waived the right to request a Screening Review or Request for Extension of Time for a Screening Review;
The Administrative Penalty shall be deemed to be confirmed;
The Administrative Penalty shall not be subject to any further review, including a review by any Court.

Please be sure that all information, including your contact information, is accurate and complete.

Penalty Notice Recipient Information

Last Name or Single Name

First Name

Middle Name (if applicable)

Primary Phone Number

Email Address

Street Number

Apartment/Unit/Level (if applicable)

Town

Postal Code

Penalty Notice Information

Penalty Notice Number

Penalty Date

Plate Number OR Address of Infraction

Please provide a detailed and factual explanation of the extenuating circumstance(s) that prevented you from submitting a Request for a Screening Review within the time limited set out in Section 6.1 of By-law 8289.

Please upload any document you think may support your Request for an Extension of Time for a Screening Review

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

Acknowledgement of the Penalty Recipient

I acknowledge that the information I have provided on this Request is true and correct, to the best of my knowledge.

I understand that the submission of this Request does not guarantee that an Extension of Time for a Screening Review will be granted and that the Screening Officer reserves the right to deny such a Request as per By-law 8289.

Failure to complete this Request may results in the Administrative Penalty (Penalty Notice) and any additional administrative fees being affirmed.

Signature

Clear

Date of Request

Privacy Statement: Personal information collected on this form is collected under the authority of the Municipal Act, 2001 and will be used for the purposes of administering the Town of LaSalle's AMPS by-law, By-law 8289. Questions about the collection of this information can be directed to the Deputy Clerk, Town of LaSalle, 5950 Malden Road, LaSalle, Ontario N9H 1S4. Phone: 519-969-7770 ext. 1256.