Required fields are marked with asterisks (*)

Request for a Hearing Review

The Town of LaSalle issues Penalty Notices (By-law and Parking "tickets") for various infractions under the Administrative Monetary Penalty System (AMPS).

If you wish to appeal a Screening Decision, you may request a review from the Hearing Officer.

This Request for a Hearing Review must be filed on or before the "Due Date" as specified on your Screening Decision, and by the person to which this Penalty Notice applies. If the Person who was given a Penalty Notice has a valid reason for missing that deadline, the Person can complete the form called Request for Extension of Time for a Hearing Review, and the Hearing Officer will review your reason(s) and grant the extension or not.

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

Important Notes: New evidence may not be submitted and cannot be considered for a Hearing Review. All the particulars upon which the Hearing Officer will render a decision are those which were previously considered by the Screening Officer.

If you received a Screening Decision from an in-person or electronic (telephone or Zoom) Screening Review but you did not attend or failed to remain at the Screening Review, please note that the Screening Decision is final.

Penalty Notice Recipient (Appellant) 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 and Screening Decision Information

Penalty Notice Number

Penalty Date

Plate Number OR Address of Infraction

Screening Decision Date

Claim of Undue or Financial Hardship

Will you be requesting that the Hearing Officer reduce, cancel or extend the time for payment based on a claim of financial or undue hardship?

Yes

Requested Meeting Format of Hearing Review

I am requesting that a Hearing Officer review my Formal Screening Decision, and I wish to (check one box):

Meet with the Hearing Officer by telephone for the Hearing Review

Meet with the Hearing Officer via Zoom for the Hearing Review

Meet with the Hearing Officer in person, at the Civic Centre, during regular business hours for the Hearing Review

Have the Review undertaken the Hearing Officer independently, without meeting with the Hearing Officer

Acknowledgement of the Penalty Recipient (Appellant)

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

I further acnknowledge that the Hearing Review will be based solely on the particulars reviewed at the Screening Review, including any evidence at the time, and that I cannot seek to introduce new evidence for a Hearing Review.

I understand that the submission of this Request does not guarantee that a Hearing Review will be granted and that the Hearing Officer reserves the right to deny such a Request per the AMPS By-law.

Failure to complete this Request may result in the Screening Decision being affirmed and additional Administrative Fee(s) may apply.

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 processing requests for Hearing Reviews per the Town of LaSalle's AMPS By-law. 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.