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Email: amps@cobourg.ca Phone: 905-372-8380Town of Cobourg, Legislative Services55 King Street West Cobourg, ON K9A 2M2
Applicants are responsible for the completion and content of this form.
Authorized Representative (To be completed if a Representative is accompanying the Penalty Notice Recipient. The Town’s Hearings Officer By-law restricts Representatives to the following: a lawyer, a licensed paralegal or a person who is exempt from the requirement to be licensed by By-law passed pursuant to the Law Society Act, R.S.O. 1990, c. L.8)
Personal information contained on this form is collected under the authority of Part IV and Section 11 of the Municipal Act, 2001 and will be used for administering the Licensing and Municipal Law Enforcement process. Questions concerning collection of personal information should be directed to the Town of Cobourg’s Freedom of Information Co-ordinator at 905-372-4301.
Penalty Notice Information (Infraction) (Please provide the information found on the Penalty Notice.)
Hearing Appointment Time Information
Reason for Hearing Request You are required to provide a factual and detailed explanation of your reason(s) for your Hearing Request.
If you wish to support your Hearing with images or other documentation please bring them with you.
Note that any evidence not presented at your Screening is inadmissible at the Hearing.
Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif
Statement of Penalty Notice Recipient
I represent and warrant that: