Fillable Citation Appeal Form (Mohawk Valley Community College)

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Citation Appeal Form (Mohawk Valley Community College)

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MOHAWK VALLEY COMMUNITY COLLEGE
Department of Public Safety
(Revised 06/19)
Citation Appeal Form
NOTICE:
All appeals to the Traffic Appeals Committee must be made within ten (10) days of the date the citation was
issued. Appeals may be submitted in person or mailed to the Department of Public Safety, at either office
location. The copy of the citation must be submitted with this appeal.
1101 Sherman Drive
Academic Building, room 109
Utica, New York 13501
1101 Floyd Avenue
Plumley Complex, room 118
Rome, New York 13440
To: Chairman, Traffic Appeals Committee
Date of Citation:
Date of Appeal:
Name:
M#:
Home Address:
State:
Zip:
Vehicle License Plate:
Citation #:
( ) I WISH TO APPEAR IN PERSON BEFORE THE COMMITTEE
( ) I DO NOT WISH TO APPEAR IN PERSON BEFORE THE COMMITTEE
I understand that all decisions of the committee are final, and if denied, the citation must be paid
within ten (10) days from the postmarked date the notification, or the fine will double.
I request the penalty of the imposed violation of the campus traffic/parking rules and regulations as per
attached parking/traffic violation be waived for the following reason(s):
Signature:
Date and Time:
____________________
Traffic Appeals Committee Use Only Department of Public Safety Use Only
Date:
____________
Date Received: __________
By: ___________
Date:
____________
Date Received: __________
By: ___________
Remarks: ________________________________________________________________________________
________________________________________________________________________________________
Signed: Committee Chairperson _____________________________________ Date: _________________
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Citation Appeal Form (Mohawk Valley Community College)

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Completed 21 July 2020

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