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Screening Request Intake Form

 

 

 

Acknowledgement:
 

 

Type of By-law Contravention
 

 

 

I am requesting that a screening officer review my Administrative Penalty based on the information provided below and I irrevocably elect to; (select one)
 
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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

 



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