HomeMy WebLinkAboutParking ticket appeal form
335 IOWA AVENUE ● IOWA CITY, IOWA 52240 ● (319) 356-5096 ● FAX (319) 356-5499
PARKING TICKET ADMINISTRATIVE REVIEW FORM
APPEALER: PRINT CLEARLY & COMPLETELY
(FIRST PAGE ONLY)
Date: ____________________________________
________________________________________
Name
________________________________________ Address
________________________________________ City State ZIP
________________________________________
Email
License
Plate #
Ticket 1 #
Amount $
License
Plate #
Ticket 3 #
Amount $
License
Plate #
Ticket 2 #
Amount $
License
Plate #
Ticket 4 #
Amount $
PARKING VIOLATION ADMINISTRATIVE REVIEW PROCEDURES:
A driver or owner of a vehicle issued a parking violation may request an administrative review of the parking violation by completing this
form. Such request shall be completed within twenty (20) calendar days from the date the parking ticket was issued. Failure to request and
complete such review within the 20 day period waives your opportunity for an administrative review. Such review is presented to a three (3)
member panel with a determination based on the defenses or mitigating circumstances set forth on the review request. The panel may
dismiss any parking ticket for good cause and any fine monies paid towards the reviewed parking violation shall be refunded, less any
unpaid parking fines then owing by the driver or owner charged.
If you disagree with a "not dismissed" decision, you may have the matter brought before a judicial magistrate for determination. ANY
VEHICLE WHICH HAS ACCUMULATED 50 OR MORE DOLLARS IN PARKING VIOLATIONS MAY BE IMPOUNDED UNLESS ALL
TICKETS ARE PAID. (Iowa City Code of Ordinances)
CAUTION: ANY STATEMENTS MADE ON THIS FORM MAY CONSTITUTE AN ADMISSION ON YOUR PART.
NOTE: IF TICKETED FOR VIOLATING HANDICAPPED PARKING REGULATIONS AND YOU POSSESS A VALID PERMIT, PLEASE
SUPPLY SS# OR PERMIT # TO ALLOW VERIFICATION:_____________________
APPEALER’S STATEMENT OF DEFENSE: (If you need more space, please attach a separate page.)
SIGNATURE DATE
DAY PHONE: __________________ HOME PHONE: __________________
335 IOWA AVENUE ● IOWA CITY, IOWA 52240 ● (319) 356-5096 ● FAX (319) 356-5499
DO NOT WRITE BELOW THIS LINE. RETURN COMPLETED FORM TO
PARKING DIVISION, CITY OF IOWA CITY, 335 IOWA AVE., IOWA CITY, IA 52240
CITY USE ONLY:
OFFICER #1 COMMENTS:
SIGNATURE
SIGNATURE
OFFICER #2 COMMENTS:
SIGNATURE
fintreas/forms/pkgticktrv-printmaster.doc