Request for Screening Review

If you disagree with the Penalty Notice you have received, you may request a Screening by completing the form below.

Ticket Information

Ticket Number

Plate Number

Registered Owner Information

First Name

Last Name

Phone number

Address

City/Town

Postal Code

I acknowledge that the Town of Innisfil's Screening Officer will rely on the information provided in this form to confirm vehicle ownership.

Check if the Applicant information is different from the Owner information above.

If you are not the registered owner of the vehicle, please complete the Authorization to Act form. The registered owner must authorize you to request a review of the penalty notice.

Applicant Information

First Name

Last Name

Phone number

Address

City/Town

Postal Code

Upload a completed Authorization Form

If you are not the owner of the vehicle, a screening request will only be processed if you have submitted the Authorization to Act as an Agent form.

Violation and Screening Information

Date Penalty Notice Issued

You must request a screening review within 30 days of the effective date of the notice. You may request an extension of time if 30 days have passed and extenuating circumstances exist, but it cannot exceed the 60-day period.

Provide the reason for the requested screening.

Please acknowledge that you understand all screenings will be in English. If you require an interpreter, you are responsible for providing your own.

I am comfortable speaking English.

I will be bringing an interpreter.

By checking this checkbox, I certify that all information provided in this application is true and accurate.

The Municipal Freedom of Information and Protection of Privacy Act applies to all information collected by the Town through this application. The information will only be collected, used and disclosed in accordance with the Act. Questions about this collection can be directed to the Clerk's Office, Town of Innisfil, 2101 Innisfil Beach Road, Innisfil ON, L9S 1A1. Telephone: 705-436-3710.

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