UNIVERSITY OF CONNECTICUT HEALTH CENTER
UNIVERSITY OF CONNECTICUT HEALTH CENTER
PUBLIC SAFETY DIVISION
POLICE DEPARTMENT
PARKING TICKET APPEAL
Return to: Parking Appeals, c/o Public Safety Division, Room LG041 MC3925
263 Farmington Ave, Farmington, CT 06030
Home/Mail Address Registered Owner of Vehicle:
Name___________________ Name_____________________
Street___________________ Street_____________________
City_____________________ City_______________________
State_________ Zip________ State_________ Zip_________
Employee____ Student____ Patient____ Contractor/Vendor____Other____
(check one)
Ticket No._______________ Vehicle License No.__________ Date Issued__________ State __________
Type of Violation_________________ Location on Campus________________
Please describe the reason for your appeal: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
____: No Payment Necessary
____: Denied
Please attach actual ticket to this appeal form
Officer’s Parking Ticket Appeal Response
Ticket Number: _______________
____ Clearly Marked Area
____ No Parking Sign
____ Painted Lines
____ Marked Crosswalk
____ Parked on Grass
____ Restricted Lot - No Visible Hang Tag – Hang Tag Expired
____ Marked Handicap Parking – No Visible Handicap Tag/Plate/Sticker
____ Fire Lane
____ Not A Designated Parking Area
____ Patient Parking
____ Other – Explain In Comments
Admin Comments:
____ Visitor/Patient
____ Valid Permit # ________________
____ Issued Multiple Tickets
____ Other – Explain In Comments
____ First/Only Ticket
Comments:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Officer:_________________ Date: __________________
Rev: 9/13
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For Office Use Only
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