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Hearing Appeal Request - AMPS

If a person wishes to dispute the screening decision, a person may request a Hearing Appeal no later than 15 days after the date of the service of the Screening Decision. Written notice of your Hearing Appeal appointment will be provided. 

All meetings will be held virtually via Zoom. If you require accommodation, you should inform the Township as soon as possible. Please advise the Township of your accommodation needs so that appropriate arrangements can be made prior to your appointment. Please note the Township does not provide translators. 

Section 1 - Penalty Notice Information

I affirm I have completed a Screening Review, and given the outcome, I intend to advance my appeal to the level of a Hearing Officer:
 

Section 2 - Defendant Information

Will you be representing yourself?
 

If you responded "no" to the question above, please complete an Agent Authorization Form. 

Section 3 - Reason for Appeal

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

PLEASE NOTE:  Supporting documents help estabilsh the validity of the request for a Hearing Review. For example, a death certificate, police report, medical note, photographs or accessible parking permit may constitute supporting documentation. All Hearing Officer decisions are final. 

If paying the Administrative Monetary Penalty will cause financial difficulty and you require additional time to pay, please send all supporting financial documents to support your claim. 

By signing this form, I certify that all information provided is true and accurate. I will notify the Township if any of the information changes before the review date. 

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