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. Waiver of Appearance Acknowledgements*

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

    1. I wish to contest the above citation and will not personally appear before a Hearing Officer.
    2. I understand the Hearing Officer will decide whether I am liable or not based on this form and any supporting information I attach.
    3. I understand if found liable, there will be a $25 Hearing Fee added to the assessed fine for the violation.
    4. I understand I will be notified by US Mail of the outcome (allow 4-6 weeks to receive notice).
36. Indicate why the ticket was issued in error or why you are not liable for this violation.
38. Upload any supporting documentation you wish the Hearing Officer to view in order to evaluate the citation.
    NOTE: Anything attached must be explained in the above section as to its relevance to your request.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field