Required fields are marked with asterisks (*)

AMPS Request Form

Important information to read prior to completing request form

Applicants are responsible for completing all required portions of the applicant portion of this form, and any false or misleading information may lead to this request being null and void.
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 the administration of the AMPS Program. Questions concerning collection of personal information should be directed to the Director of Corporate Services/Clerk.
Any supporting evidence (photos or documents) for your Screening request must be brought with you or attached to this completed form and the number of items noted.
Any supporting evidence NOT presented for the Screening is NOT ADMISSABLE at the Hearing.

To Be Completed by Applicant

Please check any of the boxes below that applies to you, as the applicant for this AMPS Request Form.

Penalty Notice Recipient

Authorized Representative

Property Owner

Vehicle Owner

Name (First and Last)

Address (Street, Town, Province, Postal Code)

Email Address

Phone Number