2. 
4. Citation Issue Number*
5. Date Issued*
   Date Issued
7. Violation Type*
   -- Select One --ParkingMunicipal
8. Violation*
   -- Select One --CLASS 1 - MetraCLASS 1 - Fire LaneCLASS 1 - Parked Where Prohibited by SignCLASS 1 - 2am-6am ParkingCLASS 1 - Barking DogCLASS 1 - Dog at LargeCLASS 1 - Parked Left Wheel to CurbCLASS 1 - Parked Blocking SidewalkCLASS 1 - Parked w/in 15 ft of Fire HydrantCLASS 1 - Parked w/in 20 ft of CrosswalkCLASS 1 - Parked w/in 30 ft of Stop/Yield Sign or Traffic Control SignalCLASS 2 - Seat BeltCLASS 2 - Child RestraintCLASS 2 - Loud ExhaustCLASS 2 - One HeadlightCLASS 2 - Taillight ViolationCLASS 2 - No lights When RequiredCLASS 2 - No Valid Safety TestCLASS 2 - Tinted WindowsCLASS 2 - No Front/Rear PlateCLASS 2 - Defective WindshieldCLASS 2 - License Plate CoverCLASS 3 - Tobacco Purchase Under 21CLASS 3 - Alcohol Possession/Consumption Under 21CLASS 3 - Cruelty to AnimalsCLASS 4 - Retail TheftCLASS 4 - Disorderly ConductCLASS 4 - TrespassingCLASS 4 - Possession of CannabisCLASS 4 - AssaultCLASS 4 - BatteryCLASS 4 - Possession of Drug ParaphernaliaCLASS 4 - Criminal Damage to PropertyCLASS 4 - TheftCLASS 5 - Handicapped ParkingOTHER / NOT LISTED
10. If violation is not listed above, indicate it here:
12. If multiple citations were issued, indicate all additional CITATION NUMBERS and VIOLATIONS here:
16. CONTACT INFORMATION
18. First Name*
19. Last Name*
21. Address1*
23. Address2
25. City*
26. State*
27. Zip*
29. Email Address*
30. Confirm Email Address*
34. Hearing Request Acknowledgements*

    You must acknowledge each of the following before submitting this form.

    1. I wish to contest the above citation and will personally appear before a Hearing Officer at the date and time assigned to me.
    2. I understand the Hearing Officer will determine if I am liable for this violation or not.
    3. I understand if found liable, there will be a $25 Hearing Fee added to the assessed fine for the violation.
    4. I agree to be contacted via email with my Hearing Date.
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field