Updated: May 2, 2018 C:\Users\broneic\Desktop\to do\4-30-18\accessible\Parking Citation Appeal Form.docx
BRCC Parking Citation Appeal Form
Vehicle Owner: Please complete this form, attach the citation in question and forward to the Public Safety
Office (Houff Student Center) within 10 calendar days of the violation.
If the appeals committee votes in your favor, the citation will be voided.
If the appeal is denied, you have thirty (30) calendar days from the date on the original citation to
pay the fine or an additional $10 late fee will be applied.
Payment is to be made at the cashier’s window in the Houff Student Center during regular business
hours (M-F, 8:30AM-5:00PM).
Please check the box that applies, and complete all requested information: PRINT CLEARLY
Student Staff Faculty
Name: _____________________________________________ Empl ID# ________________________
Address:____________________________________ ______________________ _______ _________
(street) (city) (state) (zip)
Telephone No: ________________________Email for Notification: ___________________________________________
You will be notified of the appeals committee’s decision via email.
Citation No: __________________Parking Permit No: ____________________License Plate No: __________________
You may use the lines below to explain clearly and concisely the basis for your appeal (why you think you should not
have been given or should not have to pay the citation). Please attach any corroborating evidence or statements (i.e.
doctor’s statements, repair bills, receipts or any pertinent information in addition to your statement). This form will
be sent to the appeals committee by email.
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___________________________________________ _________________________
Signature Date
Email completed form to: idcard@brcc.edu