Request for Hearing

Email: amps@cobourg.ca Phone: 905-372-8380
Town of Cobourg, Legislative Services
55 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

• Hearings are held electronically or in person every second and fourth Thursday between 1 p.m. and 4 p.m.
• Your Hearing will be scheduled for the next available Thursday afternoon.
• If you need to have your Hearing held on a day/time other than the next available Thursday you must request that the Hearings Officer extend the time to request a Hearing. This will require your attendance before the Hearings Officer on the next available Thursday afternoon to explain the reasons for your extension request (which should be detailed on this request form). Extensions of time to request a Hearing will be subject to the decision of the Hearings Officer and depending on the decision of the Hearings Officer you should be prepared to proceed with your appeal on the same day.
• If submitting your request by mail, email scanned copy or fax, a notice will be sent to you confirming the date and time of your Hearing appointment.
• The Hearings Officer decision will be provided to you at the Hearing or it will be sent to you.

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.

Statement of Penalty Notice Recipient

I represent and warrant that:

• I am the registered owner of the vehicle (for Parking Penalty Notices only); or
• I am the person named on the Penalty Notice (for Non-Parking Penalty Notices only);
• If I have reviewed the “Authorized Representative” section of this request and I authorize an “Authorized Representative” to accompany me and act on my behalf in this matter as permitted and I also understand that I must attend with the “Authorized Representative”;
• I acknowledge that if I fail to appear and to remain at my scheduled Hearing until my matter has been determined by the Hearings Officer, I will be deemed to have abandoned my request for a Hearing, the Administrative Penalty will be affirmed, I will be liable for an additional fee for having failed to appear (currently $100.00) and understand that in relation to Parking Infractions that my penalty and fees will be referred to the Ontario Ministry of Transportation for the denial of my Ontario Vehicle Permit application if the affirmed penalty and fees are not paid to the City within the time frame set out in the by-law; and
• I have read and understand the conditions of this application.