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AMPS Time Extension Request for Screening Review

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Please complete and submit this form to request an Extension of Time to Request a Screening Review of the Penalty Notice described below:

Penalty Notice number

Penalty Notice issued on

Vehicle Licence Plate Number (if applicable):

Your Name

Your Street Address

Your Apartment/Unit/Suite Number

Your City

Your Postal Code

Your telephone number

Your email address

Please describe the mitigating or extenuating circumstance that prevented you from either paying or requesting a review by the due date, and the reason you require an extension of time to either pay or request a review.

In order to be considered for an Extension of Time to Request a Screening Review, this Request must be received by the Screening Officer within 45 days of the date the Penalty Notice was issued.

The decision to grant or deny the request will be made by a Screening Officer and in accordance with the AMPS Extension of Time Policy.

The Screening Officer may grant the request if a mitigating or extenuating circumstance that warrants an extension of time is provided.

You will be notified of the decision of the Screening Officer. If the Screening Officer grants an extension, a staff member will contact you to book a Screening Review appointment.

If submitting a printed request, please send this completed Request for Extension of Time to Request a Screening Review to:

Community Standards - Adjudication Section
1200 Elgin Mills Road East
Richmond Hill, Ontario L4S 1M4

Notice of Collection

The personal information on this form is collected in accordance with the Municipal Act, 2001, and will be used in the administration of the Administrative Monetary Penalty System. Questions about this collection can be directed to the Adjudication Manager, 1200 Elgin Mills Road East, Richmond Hill Ontario L4S 1M4, by telephone at 905 771-5734, or by email to amps@richmondhill.ca.

City of Richmond Hill

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AMPS Time Extension Request for Screening Review

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