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The Corporation Of The City Of Stratford

Request For Review Of Parking Infraction Notice

Notice of Collection

The personal information collected on this form is collected by The Corporation of the City of Stratford under the authority of the Municipal Act, 2001 and will be used for the purpose of reviewing your parking ticket inquiry and administrative purposes. Questions about the collection and use of this information may be made to the City Clerk, P.O. Box 818, Stratford, Ontario N5A 6W1 or by telephoning 519-271-0250 ext. 235 during business hours.

If you require this document in an alternate format, please contact the Clerk's Office at 519-271-0250 ext. 237 or TTY 519-271-5241.

Ticket #:

Ticket Date:

Meter # and Location:

Officer #:

Name:

Address:

City:

Province (State):

Postal Code:

Phone:

Email:

Please select one of the following:

I am the registered owner of the vehicle

I am authorized by the registered owner of the vehicle to make this request for review

The reason(s) for my request:

Please upload any photos and/or documents you wish to provide as part of your request for review:

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

Please check to provide your acknowledgement

I will decide my next course of action after I receive the results of this request,I understand that if I wish to dispute the review of the ticket I will be required to come to City Hall to file a Notice of Intention to Appear:

Yes

By checking this box I hereby authorize the Corporation of the City of Stratford to complete the review of this parking infraction

Yes

Date:

Electronic Signature (sign using mouse or other input device, or if using a touch screen, your finger):

Clear