Required fields are marked with asterisks (*)

Request for Screening Officer Review Form

  • Screenings usually take between one to two weeks for a decision and reply to be sent.
  • Please read reply correspondence thoroughly as payment, and/or next step for resolution will be spelled out for your assistance.The Town of LaSalle is not responsible for the untimely deliverance of forms through Canada Post.
  • The Town of LaSalle is not responsible for the actions of Canada Post, nor the timelines of their delivery.
  • Failure to complete this form by the due date listed on any correspondence will forfeit your right for any further dispute in accordance with By-law 8289. As a result, the ticket will remain affirmed to the price listed on the ‘Notice of Administrative Penalty Late Payment Notice’ and sent to the Ministry of Transportation for Plate Denial.

Penalty Notice Recipient

Penalty Notice Information

Reason for Screening Request

  • Please provide a factual and detailed explanation of your reason(s) for disputing this Offence. If you wish to support your screening with images or other documentation, please attach them with this request. The screening decision reply will be sent to you by the method you chose as a reply preference.
Browse…

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

Statement of Penalty Notice Recipient

  • I am the registered owner of the vehicle (for parking penalty notices only); or the representing Agent.
  • The Town of LaSalle is not responsible for the actions of Canada Post, nor the timelines of their delivery.
  • Failure to complete this form in its entirety may result in the Administrative Penalty and additional fees being affirmed.

I confirm that I have read and understand the conditions of this application.

Clear

The personal information on this form is collected under the authority of the Municipal Act, 2001 and will be used for the purposes of responding to your request with respect to the Town’s Administrative Monetary Penalty System.  Questions about the collection of this information can be directed to the Deputy Clerk, Town of LaSalle, 5950 Malden Road, LaSalle, Ontario N9H 1S4, 519-969-7770 ext. 1256.