TOWN OF GRIMSBY 

www.grimsby.ca  
160 Livingston Ave
Grimsby ON L3M 0J5

905-945-9634

905-945-5010

REQUEST FOR HEARING 

Review of Town of Grimsby Screening Decision 

tickets@grimsby.ca

Tel: 905-945-9634

**You will be notified by the Town of Grimsby of the Hearing Date**

PENALTY NOTICE RECIPIENT 

PENALTY NOTICE INFORMATION (Infraction) (Please provide the information found on the Penalty Notice) 

The Town of Grimsby has entered into an Agreement with other Niagara Municipalities to provide the service of a Hearing Officer for parking and non-parking appeals that cannot be resolved by the local screening process.  Your request will be processed by the Town of Grimsby and forwarded to the host Municipality. Your Hearing will be subject to their Hearing Protocol and requirements for Hearing Appointment Times as noted below:

• Your hearing will be scheduled for the next available date;

• If you need to have your hearing held on a day/time other than the next available date you must request that the Hearing Officer extend the time to request a Hearing. This will require your attendance before the Hearing Officer on the next available date 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 Hearing Officer and, depending on the decision of the Hearing Officer, you should be prepared to proceed with your appeal on the same day; and

• If submitting your request by email, a notice will be sent to you confirming the date and time of your hearing.

**The Decision of the Hearing Officer is final and binding**

STATEMENT OF PENALTY NOTICE RECIPIENT 

I represent and warrant that: 

• I am the registered owner of the vehicle; 

• 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 Hearing 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 Town of Grimsby within the time frame set out in the By-Law; and

• I have read and understand the conditions of this application.

INSTRUCTIONS FOR SUBMITTING HEARING REQUEST FORM: 

Please submit your completed form to the Town of Grimsby: 

a) By Submitting this form Online; or 

b) In the Mail Drop Box at the Town of Grimsby, Town Hall, 160 Livingston Ave., Grimsby ON L3M 4G3

**CAN ONLY BRING EVIDENCE USED IN SCREENING TO THE HEARING**

 Personal Information contained on this form is collected and will be used for the purpose of administrating the Host Municipality's and the Town of Grimsby's Administrative Penalty process. Questions about this collection should be directed to the Town Clerk at 905-945-9634