500-00427 Parking Ticket Complaint (01/2018) Page 1 of 1
PARKING VIOLATION COMPLAINT Pursuant to 4 V.S.A. § 32(c)(11) and 24 V.S.A. § 1974a(e)(1)
Plaintiff Municipality (please print)
City of Burlington
Municipal No.
0403
Registration State
Registration #
Vermont
Defendant's Last or Organization Name
First Middle Initial
Home Phone
( ) -
Business Phone
( ) -
Mailing Address: Street
City
Zip Code
Date of Birth
- -
Male Female Corp/Organization
Violation Date
Time
Location of Violation
Defendant's vehicle was issued parking ticket # by
.
Vehicle Make Vehicle Model Vehicle Color
Defendant contested the parking violation pursuant to the municipal procedure. Defendants' appeal was
denied. Defendant exhausted the procedure provided and has not paid the fine assessed for the violation.
In Violation of Municipal Ordinance:
FINE AMOUNT $
Defendant did then and there commit the following acts:
Municipal Atty. or Responsible Official (printed)
John J King
Responsible Official Title
Parking Manager
Municipal Atty. or Responsible Official signature
Parent or Guardian Last Name
First Name
Delivered To (Def., Reg. Agent, or Corp. Officer)
Street Address
City
State
Zip Code
Date Served
- -
In Hand
U.S. Mail
Servicemembers' Civil Relief Act Declaration: Signed under penalty of perjury, I state:
Defendant said he/she is NOT on active duty in the U.S. armed forces. Defendant is under 17 years of age. Defendant is a business or corporation
Defendant said he/she IS on active duty or is scheduled to be on active duty in the U.S. armed forces.
Officer Signature ___________________________________________________________:
State of Vermont, County: CHITTENDEN COUNTY
Distribution List: Original file with Criminal Division 1 copy to Municipal Atty. or Responsible Official 1 copy to Defendant to retain for their records; 1 copy to Defendant
to return to Criminal Division; 1 copy to Defendant to return to Municipality
1. Sign here
Defendant or Corporate Officer Signature
Date
-
-
2. Mark (''X'') your plea below:
Current
Mailing
Address
Street
Home Phone
ADMITTED
-
-
NO CONTEST
City, State, Zip
Work Phone
DENIED (state reason below)
If you plead DENIED, state your reason why:
-
-
Parent or
Signature
Date
-
-
Guardian of
Defendant
Street
Home Phone
Under 18
-
-
Years
of Age
City, State, Zip
Work Phone
-
-
IF YOU PLEAD ADMITTED OR NO CONTEST: Mark your plea and sign above. Deliver your plea to the Criminal Division and the Municipality within 21
days with payment of the FINE AMOUNT shown on the front of the Complaint. Pay by check or money order in U. S. funds, make checks payable to VT
Superior Court. Judgment will be entered against you. IF YOU PLEAD DENIED: Mark your plea, sign and state your reason why above. Deliver your
plea to the Criminal Division with 21 days. You will be scheduled to appear in court. IF YOU FAIL TO DELIVER A PLEA WITHIN 21 DAYS: Judgment
will be entered against you by default and you will be liable for the FINE AMOUNT.
Deliver your plea in person or by mail to:
Chittenden Criminal Division
32 Cherry Street Suite 300
Burlington, VT 05401
And to:
Office of the City Attorney
140 Church Street Room 11
Burlington, VT 05401
Date: