Required fields are marked with asterisks (*)

Request for Review by Screening Officer

A person who wishes to submit a Request for Review by Screening Officer for the issuance of an Administrative Monetary Penalty shall file this complete application within 15 days of the issuance of an Administrative Monetary Penalty, as per By-law 2023-048. If you have received multiple APNs, a separate form is required to be completed for each APN.

Administrative Penalty Notice Number:

Are you the person that received the APN?

Yes

Name:

Corporation or Partnership:

Address

Telephone Number

Email Address

Reason to request the Screening Review (Please Select One)

There is a defective form or substance (error) on the APN

The APN was not served accordingly

Undue financial hardship

I have evidence to indicate that the by-law contravention did not occur

I believe I took all reasonable steps to prevent the contravention from occurring

Please attach any additional documentation that you feel would support your dispute.

Browse…

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

Declaration

The information contained in this application and any other attached documentation is true to the best of my knowledge. If the owner is a corporation or partnership, I have the authority to bind the corporation or partnership.

Date:

Personal information contained in this form is collected under the authority of the Municipal Act, S.O. 2001, c.25, as amended and will be used to process the applicant’s Request for Review of the Screening Officer. Questions about this collection can be directed to the By-law Division, 1 Bailey Street, Port Carling, ON P0B 1J0, 705-765-3156, bylaw@muskokalakes.ca