PARKING SERVICES DEPARTMENT

Parking Violation Appeal Form

Appeal Date: 9/2/2014

Citation No.  

License Plate No.      State:   OR              Vin No.                

      

First Name:     M.Initial

Last Name:

Address:   

City:             State:  Zip:

Email:            

Telephone:  xxx-xxx-xxxx       

Decal Type:                  Decal No.            

Date of ticket:

Please Note: In order to appeal, the date of ticket must be no later than 3 days from appeal date.

<September 2014>
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31123456
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2829301234
567891011

Time of Ticket:

Ex: 2:10pm     

APPEAL:

I wish to appeal the above referenced violation for the following reasons:

Type of Violation: