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2. Your Name*
3. Email Address*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number*
12. Fax Number
14. Ticket Number*
15. Location Where Ticketed*
17. Date and Time When Ticketed*
    Date and Time When Ticketed

    Date and Time When Ticketed
18. File Upload (Optional)
    You may upload a picture of the area where you were ticketed if you like.
20. Reason Ticket Should Be Voided*
    Please explain why you think the ticket should not have been issued.
22. Electronic Signature Agreement*

    By checking the "I agree" box below, you understand that by typing your name on this appeal you are certifying that the facts stated in it are true to the best of your knowledge.

    1. I agree.
24. Electronic Signature*
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field