Parking Ticket Appeal Form

* denotes required field

Date of Appeal

Date of Appeal:

Contact Information

NetID:

First Name:

Last Name:

Residence Hall:

If on-campus

Mailbox Number:

If on-campus

Address:

City:

State/Province:

Zip Code:

E-Mail Address:

Phone Number:

Parking Permit Information

Parking Permit Number:

Year of Permit Expiration:

Affiliation:

Student

Faculty/Staff

Visitor

Other

License Plate Number:

State where Licensed:

Violation Information

Violation Notice Number:

In upper right corner of ticket

Location of Violation:

Officer Number:

Violation Date:

Violation Time:

Reason for Violation:

unauthorized area, etc.

Briefly state reason for appeal:

CU-URLcapture