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NOTICE

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To the attention of the distributor:

Please be advised, as well as the City of Dieppe, as owner or occupant I am requesting the non-distribution of free documents as per bylaw A-15 of the City of Dieppe entitled “Bylaw respecting free handouts distribution in the City of Dieppe” for the following address:

Applicant's name

Email address

Civic number

Street name

Apartment

Postal code

PO box

153BG04.20

Personal information on this form is collected under the authority of the Right to Information and Protection of Privacy Act and the Personal Health Information Privacy and Access Act for the purpose of processing your application. Questions about this collection of personal information can be directed to the Clerk, 333 Acadie Avenue, Dieppe, New Brunswick, E1A 1G9, 506.877.7900.

When you press the "Submit" button, your request will be automatically forwarded to Brunswick News (blue advertising bags) as well as to the City of Dieppe.