Citation Appeal Form

Today's Date:
Name:
Address:
City:
State:
ZIP:
Home Phone:
Cell Phone:
E-mail:
 
TWU Resident:
Yes No
If Yes,
Dorm: Room
 
How do you want to be contacted with resulty of your appeal?
Mail Phone Call E-mail:
Please note that if “Phone call” is chosen, messages left of voicemail constitutes contact being made.
   
Ticket Information
Ticket #: Date:
Time: Violation#:
Location
 
vehicle Information
Make: Model:
Color: Year:
License Plate: State:
Permit #:
 

Appeal Statement (your specific Reason for this appeal)