Required fields are marked with asterisks (*)

Request for Extension of Time - AMPS

I hereby request an Extension of Time for a:

Screening Review (I have not had a Screening Review yet)

Hearing Appeal (I have had a Screening Review already)

Penalty Notice Information

Penalty Notice Number

Penalty Notice Issue Date

Vehicle Licence Plate No. (if applicable)

Contact Information

Name

Address

Postal Code

Phone Number

Email Address

Date of Request

Please explain the mitigating or extenuating circumstances that warrant an extension of time:

Please attach supporting documentation:

Browse…

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

Signature

Clear

Date

In order to be considered for an Extension of Time, this request must be received by the Township of Algonquin Highlands within 45 days from the date of the issuance shown on the Penalty Notice.

The Township may grant an extension and set a date for a Screening Review or Hearing Appeal only if the Applicant demonstrates, on a balance of probabilities, the existance of mitigating or extenuating circumstances that warrant an Extension of Time.

You will be notified of the decision by email.

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