<form-template> <fields> <field type="date" required="true" label="Date you received the ticket:" class="form-control calendar" name="date-1650379796578"></field> <field type="text" subtype="text" required="true" label="Time you received the ticket (hh:mm am/pm):" class="form-control text-input" name="text-1650379749221"></field> <field type="text" subtype="text" required="true" label="Offence Ticket Number:" description="Located at the top left of the ticket underneath the barcode" class="form-control text-input" name="text-1650379749438"></field> <field type="file" label="Upload Supporting Evidence (documents or photos) " class="form-control file-input" name="file-1650379767704"></field> <field type="text" subtype="text" required="true" label="First Name:" class="form-control text-input" name="text-1650379750536"></field> <field type="text" subtype="text" required="true" label="Last Name:" class="form-control text-input" name="text-1650379750872"></field> <field type="text" subtype="text" label="Telephone Number:" class="form-control text-input" name="text-1650379751552"></field> <field type="text" subtype="text" required="true" label="Email:" class="form-control text-input" name="text-1650379751808"></field> <field type="text" subtype="text" label="Street Number &amp;amp;amp; Name:" class="form-control text-input" name="text-1650379752192"></field> <field type="text" subtype="text" label="PO Box Number:" class="form-control text-input" name="text-1650379752416"></field> <field type="text" subtype="text" label="City:" class="form-control text-input" name="text-1650379752870"></field> <field type="text" subtype="text" label="Province/State:" class="form-control text-input" name="text-1650379753205"></field> <field type="text" subtype="text" label="Postal Code/ZIP:" class="form-control text-input" name="text-1650379754000"></field> <field type="text" subtype="text" label="Country:" class="form-control text-input" name="text-1650379754574"></field> <field type="select" required="true" label="Complaint or Request to Withdrawal Ticket:" class="form-control select" name="select-1650379757308"> <option value="Select One" selected="true">Select One</option> <option value="Bylaw Complaint">Bylaw Complaint</option> <option value="Request to withdraw ticket">Request to withdraw ticket</option> </field> <field type="textarea" label="Complaint/Concern Details:" class="form-control text-area" name="textarea-1650379763636"></field> <field type="paragraph" subtype="p" label="FOIP Statement: Your personal information is being collected by the Municipality of Jasper in order to collect complaints and issues and to allow for a response to complaints and issues. Your information is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act (FOIP). If you have any questions regarding the collection of this information, contact the Bylaw Department at 780-852-5514 or bylaw@town.jasper.ab.ca. Please note: Your complaint or issue may be considered as a public document and could be published in a public Council meeting agenda package, available on the website." class="paragraph"></field> </fields> </form-template> Submit Submitting...
