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Request for Extension - Screening Review

Acknowledgement:

I am requesting that review of my request for extension for the purpose of holding a Screening Hearing and I have provided the following information to support my request.

Penalty Notice # (e.g. 1531-A####)

Penalty Notice Date (MM/dd/YYYY)

Type of By-law Contravention

Property Standards (By-law 2023-XX)

Clean Yard (By-law XX)

Off Road Vehicle (By-Law XX)

Parking (By-law XX)

Noise (By-law XX)

Animal Control (By-law XX)

Vehicle plate (if applicable)

Location of Penalty Notice

First Name (given name)

Last Name (surname)

Email address

Phone Number

Please indicate in detail the grounds upon which you are requesting an extension for review by a Screening Officer. If an extension is granted, you will be required at a later date to provide further information to dispute the Penalty Notice. If you fail to provide this information the penalty will be affirmed. Additional late fees may apply.

Please indicate in detail the grounds upon which you request an extension for review by a Screening Officer.

If you have any supporting documents, please upload them here;

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

Please note: HBM administrative staff will contact you regarding your request and screening review dates.