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Public Complaints Respecting the Administrative Penalty System Program

This form is provided in accordance with the Public Complaints respecting APS Policy.

Public complaints must be made in writing and submitted within thirity (30) days of the event for which the complaint is being made. Anonymous complaints are not accepted.

First Name

Last Name

Street Address

Town

Province

Postal Code

Phone Number

Email Address

Penalty Notice Number

Date of event for which complaint is being made

Please describe your complaint, providing as much detail as possible.

Please upload any documents, photographs or other material that you would like to include with your complaint.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Statement - Online Form Submission

By submitting this online form to the Municipality, the user acknowledges that the submission is deemed to be a substitute for the user's signature on the online form and signifies that the user has read, understood and agreed to the terms and conditions of the online form and any document referenced in the online form.

Please confirm that you have read and accept the "Statement - Online Form Submission"

Yes, I have read and accept the "Statement - Online Form Submission"

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act, 2001 and will be used for the purpose of administering the Municipality’s Administrative Penalty System Program. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, N8H 2Z9, Telephone: 519-326-5761.

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