Request Form For Review Parking Violation/towing printable pdf download

Request Form For Review Parking Violation/towing

CITY OF NEW HAVEN

DEPARTMENT OF TRANSPORTATION, TRAFFIC &

PARKING

REQUEST FOR REVIEW

PARKING VIOLATION/TOWING

THIS FORM WILL NOT BE PROCESSED IF ILLEGIBLE OR INCOMPLETE



DATE: ___/___/___

TICKET REVIEW

TOW REVIEW

NAME: _________________________________ PHONE: _________________

ADDRESS: ______________________________________________________

CITY: ______________________________ STATE: _______ ZIP: __________

VEHICLE OWNER: ________________________ PHONE: ________________

ADDRESS: ______________________________________________________

CITY: ______________________________ STATE: _______ ZIP: __________

LICENSE PLATE NO.: ___________________

STATE: _________________

VIOLATION NO.: ___________________

TICKET NO: _________________

DATE TICKET ISSUED: ___/___/___

SHIELD NO: _________________

MAKE: _______________ YEAR: _____

MODEL: ____________________

IF TOWED, GARAGE TOWED TO: ___________________________________

NATURE OF COMPLAINT: _________________________________________

___________________________________________________

THE FILING OF THIS FORM WITH THE DEPARTMENT OF TRAFFIC AND PARKING WITHIN 15 DAYS OF THE

ISSUANCE OF THE TICKET WILL DEFER THE ACCUMULATION OF PENALTIES ON THIS TICKET UNTIL THE

OWNER IS NOTIFIED IN WRITING OF THE RESULT OF THE REVIEW.

I HEREBY CERTIFY UNDER THE PENALTY OF FALSE STATEMENT THAT THE ABOVE

INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE: ___________________________________ DATE:___/___/__

MAIL THIS FORM WITH

CITY OF NEW HAVEN PARKING VIOLATION CENTER

PARKING TICKET TO:

PO BOX 3214, Milwaukee, WI 53201-3214

Request Form For Review Parking Violation/towing