City of Winnipeg
495 Portage Avenue • Winnipeg, MB • R3B 2E4 • www.theparkingstore.winnipeg.ca • 311
ADJUDICATION RESULT REQUEST
Date of Request:
Applicant Information
Last Name First Name
Address Postal Code Province
Daytime Phone Email
INSTRUCTIONS
1. Print clearly your name, contact information, date of request and adjudication information.
2. Complete all information fields for each Adjudication Decision requested.
3. This form must be submitted in person at 495 Portage Avenue during regular business hours. Monday-Friday 08:30-17:00
4. COST: Payment is required before your request will be processed. A fee for each adjudication decision requested will be
applied based on the Winnipeg Parking Authority fee schedule.
5. Requests will be processed within three business days. You will be notified once the records are available for pickup.
6. You may request that the records be sent electronically in .pdf format.
Yes, I wish to receive the records electronically
Your personal information is being collected under the authority of s.36(1)(b) of The Freedom of Information and Protection of
Privacy Act. This information will be used to administer your request and will not be used or disclosed for any other purposes, except
as authorized by law. If you have any questions about the collection of this information, contact the Corporate FIPPA Coordinator by
mail to City Clerk’s Department, Administration Building, 510 Main Street, Winnipeg MB,
R3B 1B9, or by telephone at 311.
Applicant Signature Application Date
Office Use Only:
Email
Pick-up
Confirm ID
Received By:
Date Received:
Processed By:
Date Processed:
click to sign
signature
click to edit
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