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Reopening Application/Affidavit

REOPENING APPLICATION/AFFIDAVIT

^{ONTARIO COURT OF JUSTICE}

^{PROVINCE OF ONTARIO}

^{Under subsection 11(1) of the Provincial Offences Act}

^{Form 102.1}

^{Courts of Justice Act}

^{R.R.O. 1990}

^{Reg. 200}

I, (name)

of, (street number) (street name)

(apartment number)

(municipality)

(postal code)

Phone Number

Email address

make an application to strike out the conviction entered against me. In support I confirm and assert as follows:

1. I was convicted without a hearing of

Offence Description

File No.

Offence Date

Conviction Date

2. Through no fault of my own,

(a) I did not have the opportunity to dispute the charge at trial, or

I did not have the opportunity to attend an early resolution meeting, OR

(b) I did not receive delivery of a notice or document relating to the offence, namely Offence Notice, or

I did not receive an Early Resolution Meeting Notice, or

I did not receive a Notice of Trial

Please explain or attach other evidence or information to be relied upon in support of your application.

Attach other evidence, if needed (optional)

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

3. The conviction first came to my attention on

Check the box below if it applies

4. I have made a previous application for reopening in relation to this matter.

Signature of Defendant

Clear

NOTE: Section 86 of the Provincial Offences Act provides:

Every person who makes an assertion of fact in a statement or entry in a document or form for use under this Act knowing that the assertion is false is guilty of an offence and on conviction is liable to a fine of not more than $2,000.
Subsections 11 (2) and (3) authorize the clerk of the court or justice to strike out a conviction on affidavit of the defendant or on other evidence or information that through no fault of the defendant, the defendant was unable to participate in the proceeding.

The court may contact you regarding this application using the phone number or e-mail address provided.