H1

Required fields are marked with asterisks (*)

Ticket Dispute Form

Ticket Information

Ticket Type

Parking Ticket

Other Bylaw Offense

Parking Ticket/Bylaw Number

Date of Issue

Applicant Information

First Name

Last Name

Address

City / Town

Province / State

Country

Postal / Zip Code

Primary Phone Number

Secondary Phone Number

Email Address

Reason for Dispute

A $25.00 fee is added to the total fine if the Adjudicator finds the offence did occur.

OVERDUE PENALTIES AND FEES MAY BE REFERRED TO COLLECTIONS

Signature

I understand that the personal information on this form is collected by the City of Prince George for the purposes of bylaw enforcement, under the authority of section 26(b) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact Manager of Bylaw Services, at 1100 Patricia Boulevard, Prince George, BC, or by telephone 250-561-7600.

Learn more information about the collection of personal information under the Freedom of Information and Protection of Privacy Act.

Agreement

I agree to and acknowledge all of the terms of this application

Applicant's Legal Name