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Request for Review by a Hearing Officer

I hereby request a Review by the Hearing Officer of the Penalty Notice described below:

Penalty notice number

Penalty notice issued on

First Name

Last Name

Street Address

Town/City

Province

Postal Code

Phone Number

Email address

In order to be considered for a Hearing Review, this Request for Review by Hearing Officer must be received by the AMPS Unit Hearing Officer on or before the due date shown on the Decision of the Screening Officer.

A Notice of Appointment for Hearing Review will be mailed to you with the date, time, and location of the scheduled Hearing Review.

If you do not attend the Hearing Review at the scheduled time, an administrative fee of $50 will be added to the amount of the Penalty Notice.