ADMINISTRATIVE HEARING BOARD
Division of Code Enforcement
Appeal Request Form!
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Revised!3/14/2017!
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Please ensure you are completing this appeal request form within the time allocated by law and for an appealable action. If
your appeal is received by this office within the timeframe indicated on the citation you have been issued , then you will be
contacted by phone and/or via US Mail and provided with a time and date your appeal will be heard. Any request for appeal
that falls outside the indicated timeframe will be denied and a letter will be sent advising you of such. ”.
Appeals may be filed via U.S. Mail or by delivering the request to: Division of Code Enforcement, C/O Secretary of Administrative Hearing
Board, 101 East Vine Street, Suite 500, Lexington, KY 40507, or by faxing the appeal request to (859-425-2274)—No emails. Other appeal
related questions can be answered by your Case Officer or the Board Secretary by calling 859-425-2255.
Re: Property: _________________________________________________________________
Case #: ___________________________ Citation Amount: ________________
Case Officer: _____________________ Date of Issuance: _______________
Petition of Appellant
The undersigned, as the owner of the property designated, hereby appeals the decision of the code official, or his
designated agent, of the Lexington-Fayette Urban County Government and requests a hearing before the Administrative
Hearing Officer/Board.
Complete Contact Information for Owner (Required)
Name: _______________________________________________________________________________________
Street Address: _______________________________________________________________________________
City: ______________________________________ State: __________________ Zip: __________________
Owner’s Phone Number: (________)___________________ Other Phone: (________)____________________
Grounds for Appeal: ___________________________________________________________________________
_____________________________________________________________________________________________________
_______________________________________________________________________________
__________________________________________________(Attach Additional Documents if Needed).
Will Appellant/Owner be Represented by Counsel? _______Yes ______No (Not Required).
Name of Counsel: ___________________________________ Phone: (_________) ____________________
Printed Name of Person Completing This Appeal: ________________________________________________
Relationship to Owner: ____________________________________________________________ (N/A If Owner)
If the property owner cannot attend, then he/she must provide a notarized letter indicating that the person attending the
hearing in their stead has legal right to represent them in the hearing. If this is not provided, then the case may not be
heard or the citation may be upheld by the Hearing Officer without a rescheduling of the hearing.
____________________________________________ _________/_______/_______ (________)____________________
Signature of Requesting Party Date Phone
