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2. To dispute a Bylaw Enforcement Notice, please complete the following form. A Screening Officer will ​contact you by phone, email or mail to notify you of the outcome of the dispute or ask for additional information. Please note that disputes will only be considered if there is a valid reason. Bylaw notices will not be dismissed for such reasons as: You have never received a ticket for this violation in the past, you were unaware of the bylaw, nobody else has received a ticket for a similar violation, the bylaw seems unfair.
4. Ticket Type

   1. Parking Ticket
   2. Other
5. Bylaw Enforcement Notice Number
6. Date of Issue
   Date of Issue
8. Applicant Information
10. First Name*
11. Last Name*
13. Address*
15. City*
16. Province/State*
17. Zip Code*
19. Primary Phone Number*
20. Secondary Phone Number
21. Email Address*
23. Reason for Dispute*
25. Upload an Attachment to Clarify Your Dispute
26. Preferred Method of Communication*

    1. Email

    1. Phone
28. Freedom of Information and Protection of Privacy Act

    I understand that the personal information on this form is collected by the City of Coquitlam for the purposes of bylaw enforcement, under the authority of section 26(b) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information, please contact the Manager of Bylaw and Animal Control Services, at 3000 Guildford Way, Coquitlam, BC, or by telephone 604-927-7350.

30. 1. I agree to and acknowledge all of the terms of this application
32. Applicant's Legal Name*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field