HEARING FORM

PLEASE PRINT

Today’s Date:______/________/_______

Name:___________________________________Address:___________________________City/Town:_______________________

State:__________ Zip:__________ Ticket Number:_____________________ Date Issued:__________________

Registration#:_______________ State:_______ Vehicle Make:________ Type of Violation:_____________

Hearing/Appeal: General Law, Chapter 90, Section 20 ½ as amended. A plea of not guilty must be made in writing accompanied by explanation and supporting documentation and received by the Parking Clerk’s Office before the payment due date. Disputes will not be handled in person or over the telephone.

I wish to appeal this parking violation for the following reason(s):

______________________________________________________________________________________________________

_________________________________________________________________________________________________________

____________________________________________________________________________________________

_________________________________________________

FOR USE BY HEARING OFFICER ONLY:

APPEAL APPROVED____ APPEAL DENIED

COMMENTS_________________________________________________________________________

HEARING FORM

PLEASE PRINT

I wish to appeal this parking violation for the following reason(s):

FOR USE BY HEARING OFFICER ONLY:

APPEAL APPROVED__________ APPEAL DENIED______

APPEAL APPROVED____ APPEAL DENIED