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Administrative Penalty System Undue Hardship Consideration Form

Please complete this form to file a claim of undue hardship. Undue hardship is determined on a case-by-case basis. Supporting documentation is required in your submission. Failing to provide the necessary documents, may result in your submission being denied. The form will be reviewed, and a response will be provided to you within 21 days. If you have any questions about this form or supporting documents please contact parking@whitby.ca.

First name:

Last name:

Email:

Mailing address:

Town/City:

Postal code:

Phone number:

Preferred method of contact:

Mail

Please provide your Penalty Notice number:

Requesting consideration of the “Undue Hardship Claims Respecting the Administrative Penalty System (APS) Procedure for the following:

An extension of time to pay the Administrative Penalty and/or Administrative Fee(s)

Financial hardship,

Absence from the municipality.

Other circumstance for consideration

Please provide any relevant supporting documentation, such as financial statements, pay stubs, etc.:

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Please provide any information you would like reviewed as part of consideration:

Town of Whitby

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Administrative Penalty System Undue Hardship Consideration Form