Required fields are marked with asterisks (*)

Request for Early Resoultion Hearing

I, __________________

Address line 1:

Address line 2:

Town/City:

Postal Code:

Email Address:

Phone Number:

Parking Infraction Notice Number

The reason(s) for my request and/or evidence:

Please remember to attend the Municipal office located at 181 Perry St. Port Perry with any evidence you wish to present.

I understand that if I fail to attend the scheduled meeting, I will be deemed not to dispute the charge and may be convicted in my absence (Please provide a signature)

Clear

Date:

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