This Is an Alternate Format of Form 152 Prepared for Persons with Disabilities. Note To

This is an alternate format of Form 152 prepared for persons with disabilities. Note to screen-reader users: Use the arrow keys to navigate through this form instead of the tab key.

Form 152: Application Affidavit for a Reopening Courts of Justice Act Under subsection 19(2) of the Provincial Offences Act

O. Reg. 950

ONTARIO COURT OF JUSTICE

PROVINCE OF ONTARIO

I (name)

of (address)

apply to reopen my conviction for a parking infraction. In support I make oath

POA 0806 (November 2003) CSD

of 4 affirm and say as follows:

I was convicted without a hearing on the

day of

, year

, of the offence of contrary to section

I did not have the opportunity (check the appropriate box)

(a) to dispute the charge

(b) to appear, or to be represented

(c) to plead guilty POA 0806 (November 2003) CSD

of 4 at a hearing for the reason that, through no fault of my own, I did not receive a notice or a document relating to the parking infraction.

My conviction first came to my attention on the day of

, year

Sworn Affirmed before me at this day of

, year

Signature

of 4 A Commissioner, etc.

THE FOLLOWING IS FOR COURT USE ONLY Application denied pursuant to subsection 19(2) of the Provincial Offences Act; OR Conviction is struck out, a plea of guilty is accepted and the set fine imposed; OR Conviction is struck out and a Notice of Trial shall be given.

Justice of the Peace in and for the Province of Ontario Date

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 uder 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.