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2. Choose from the following*

   1. Administrative Appeal Process (by mail or e-mail).
   2. In-Person Hearing with Hearing Officer (Only request an In-Person hearing if your original, written appeal was denied. In-person hearings are held virtually.)

   If this is your first appeal of a specific ticket, you must select the administrative appeal process and submit a written statement explaining why you believe the ticket should be dismissed. In-Person hearing requests will only be honored after an initial written (administrative) appeal has been denied. In-person hearings will be held via Zoom, phone, or other acceptable remote methods.

4. First Name*
5. Last Name*
7. Email*
9. Mailing Address*
11. City*
12. State*
13. Zip Code*
14. Telephone*
16. Ticket Number*

    6 or 10 digit number at the top of the ticket.   (One ticket per appeal)

17. Date of Violation*
    Date of Violation

    Date the ticket was issued.

18. State of Registration*
    -- Select One --AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

    State where the vehicle is registered. If the vehicle bears a Canadian or US Government plate, indicate so in the Registration field.

19. Registration Number*

    Vehicle's license plate number.

21. Basis for Appeal*
23. Payment Disclaimer*

    1. I understand that if this ticket is paid while the appeal is pending, the payment shall serve as the final disposition of the matter in accordance with state law and I will forfeit my right to appeal
25. Violation Code*

    Violation(s) checked on the ticket. (Check all that apply)

    1. Schedule A $100 Each
    2. 27: 72-Hour (Abandonment)
    3. 04: Bus Stop
    4. 07: Crosswalk
    5. 06: Driveway - Block / Impede
    6. 26: Double Parked
    7. 29: Emergency Vehicle Zone
    8. 16: Fire Hydrant (Within 10 Feet)
    9. 17: Fire Station Exit / Entrance (30 Feet)
    10. 19: Obstruction of Traffic
    11. 25: Private Road or Way
    12. 01: Restricted Area - Fire Lane
    13. 08: Sidewalk - Upon Any
    14. 18: Within Intersection
    15. 35: Other (Describe in Basis for Appeal)
    16. Schedule B $40 Each
    17. 13A: Commercial Vehicle - 1 Hour Limit on Street
    18. 13B: Commercial Vehicle - 1 Hour Limit Municipal Lot
    19. 13C: Commercial Vehicle - No Overnight at Town Landing
    20. 22: Obstruction of Snow Plowing or Snow Removal
    21. 23: Snow Warning / Parking Ban in effect
    22. 34: Street Sweeping
    23. 36: Other (Describe in Basis for Appeal)
    24. Schedule D $300 Each
    25. 20A: Handicapped Space
    26. 20B: Handicapped Ramp
    27. Schedule C $25 Each
    28. 01A: No Parking - Loading Zone

    1. 01B: No Parking - Any Time
    2. 01C: No Parking - This Side
    3. 01D: No Parking - Here to Corner
    4. 01E: No Parking - Travel Lane
    5. 01F: No Parking - Island/Center Strip
    6. 01G: No Parking - Tow Zone
    7. 14: Parking Over Posted Limit: On Street
    8. 14A: Parking Overtime - Posted 15 Minutes
    9. 14B: Parking Overtime - Posted 30 Minutes
    10. 14C: Parking Overtime - Posted 1 Hour
    11. 24: Municipal Lots: Over Posted Limit
    12. 10: Angle - Parallel Parking Zone
    13. 11: Angle Parking Only
    14. 12: Designated Area (Street or Lot)
    15. 37: Display for Sale
    16. 33: Expired Inspection Sticker
    17. 32: Expired Registration Sticker
    18. 15: Left Wheels to Curb
    19. 02: Over 12 Inches from Curb
    20. 28: Public Assembly
    21. 30A: Resident Permit - Failure to Display Permit
    22. 30B: Resident Permit - Failure to Display Visitor Placard
    23. 30D: Resident Permit: - Expired Permit
    24. 30C: Resident Permit - Visitor Placard Over 3 Day Limit / Misuse / Expired
    25. 05: Taxi Cab Stand
    26. 09: Within 20 Feet of Intersection
    27. 03: Wrong Direction
    28. 31: Other (Describe in Basis for Appeal)
27. Permit Number

    If you are appealing a Resident Permit violation and you believe you had a valid permit, provide the permit number.

28. Permit Type

    1. Resident Parking Sticker
    2. Visitor Placard
    3. Temporary Placard
    4. Other (Describe in "Basis for Appeal")

    What type of Resident Permit was on the vehicle?

30. Attachment 1

    Attach documents, photos, etc. in support of your appeal

32. Attachment 2
34. Attachment 3
Leave This Blank:


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

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field