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
Registration State
Registration #
Vermont
Defendant's Last or Organization Name
First Middle Initial
Male Female Corp/Organization
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:
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
Delivered To (Def., Reg. Agent, or Corp. Officer)
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
Defendant or Corporate Officer Signature
2. Mark (''X'') your plea below:
DENIED (state reason below)
If you plead DENIED, state your reason why:
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: