<p>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.</p><p>Form 152: Application Affidavit for a Reopening Courts of Justice Act Under subsection 19(2) of the Provincial Offences Act</p><p>O. Reg. 950</p><p>ONTARIO COURT OF JUSTICE</p><p>PROVINCE OF ONTARIO</p><p>I (name)</p><p> of (address)</p><p> apply to reopen my conviction for a parking infraction. In support I make oath</p><p>POA 0806 (November 2003) CSD </p><p>Page 1 of 4 affirm and say as follows:</p><p>1.</p><p>I was convicted without a hearing on the</p><p> day of</p><p>, year</p><p>, of the offence of contrary to section</p><p>2.</p><p>I did not have the opportunity (check the appropriate box)</p><p>(a) to dispute the charge</p><p>(b) to appear, or to be represented</p><p>(c) to plead guilty POA 0806 (November 2003) CSD </p><p>Page 2 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.</p><p>3.</p><p>My conviction first came to my attention on the day of</p><p>, year</p><p>Sworn Affirmed before me at this day of</p><p>, year</p><p>Signature </p><p>POA 0806 (November 2003) CSD </p><p>Page 3 of 4 A Commissioner, etc.</p><p>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.</p><p>Justice of the Peace in and for the Province of Ontario Date</p><p>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.</p><p>POA 0806 (November 2003) CSD </p><p>Page 4 of 4</p>