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Market Centre Parkade Lost Parking Stub Appeal Form

Vehicle Information

Make of Vehicle

Colour of Vehicle

Licence Plate Number

Customer Information

First Name

Last Name

Address

Phone Number

Parking Stub Details

Date of Entry MM/dd/yyyy

Time of Entry 12:00 PM

Entry Point: (select one of the following)

Icomm Drive

Brantford Farmers' Market

Hill Street

Wharfe Street

Exit Point: (select one of the following)

Icomm Drive

Brantford Farmers' Market

Hill Street

Wharfe Street

Applicant Consent

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application.

Personal information, as defined in the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected and authorized under Section 10(1) of the Municipal Act, 2001, and will be used to process this complaint. You may be contacted for more information. Questions about this collection can be directed to the Senior Municipal Law Enforcement/Property Standards Officer 58 Dalhousie St, Brantford, ON N3T 2J2, or bylaw@brantford.ca.