Fill - Free fillable Delta College REQUEST FOR APPEAL TO THE PARKING APPEAL BOARD PDF form

DELTA COLLEGE

PARKING APPEAL BOARD

UNIVERSITY CENTER, MI 48710

REQUEST FOR APPEAL TO THE PARKING APPEAL BOARD

A lost ticket, parking only for a short period, parking in a nearly empty lot, not knowing the regulations

and/or not seeing the sign(s) are UNACCEPTABLE GROUNDS FOR APPEAL. Clarity should be the

deciding factor in your appeal. You will be notified, by copy of this appeal, of the hearing decision.

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(Please print with a pen)

College ID # : _____________________________________ Telephone # : ______________________

Name : __________________________________________ Date Appeal Filed : __________________

Street Address : ___________________________________ Date of Ticket : _____________________

City/State/Zip : ____________________________________ Ticket # : _________________________

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I wish to request relief from the indicated parking ticket for the following reason(s) : __________________

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For additional space continue on the back or use another sheet. Diagrams are strongly recommended.

ATTENTION APPELLANT: DO NOT FILL OUT BELOW THIS LINE

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COMMITTEE DECISION : DISMISS SUSTAIN

FACULTY _______ _______

ADMINISTRATOR _______ _______

STUDENT _______ _______

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TO : ___________________________ TICKET # : ___________ DATE OF DECISION : ____________

_______ The charge is dismissed. No fine is due.

_______ The charge is sustained. A fine of $_______ is due for the violation. IF NOT PAID WITHIN 21 DAYS, THE

FINE WILL DOUBLE AND A $ 2.00 SURCHARGE WILL BE ADDED.

NOTE : Fines should be paid in person, by check, or by money order.

COMMENTS : _________________________________________________________________________________

PARKING TICKET APPEAL BOARD

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