Form Builder

full bike rack

Required fields are marked with asterisks (*)

Request for an Appeal of a Screening Decision

Pursuant to Sections 13 and 14, of By-law 20-073, as amended, of the City of Peterborough

Instructions for Person completing this form

All the particulars upon which this appeal will be determined were submitted to the Screening Officer. There is no mechanism to submit new evidence on an appeal. 

Please review By-law 20-073 and pay particular attention to Sections 13 and 14. The Request for an Appeal of a Screening Decision must be filed before before 4:30 p.m. on the 21st day after the Screening Decision Date by the registered owner of the motor vehicle to which this Penalty Notice applies. If you are requesting an Extension of Time to Request an Appeal, please use this form Extension of Time to Request an Appeal.

If you do not attend and remain at the Hearing at the scheduled time or pay the amount shown on the Penalty Notice, an administrative fee of $100 will be added to the amount of the Penalty Notice. 

If you have any problems completing this form, please email 

Please double-check all information, including your contact information, to make sure that it is accurate and complete. 


If you received a Screening Decision from an in-person or electronic Screening, but you:

  1. did not attend the Screening; or
  2. failed to remain at your Screening,

then that Screening Decision is final and may not be appealed.