(318) 487-7233 (318) 308-6505
Louisiana College
Department of Safety and Security
Citation Appeal Form
Section 1 – Customer Information
I am filing this appeal as a: Student Faculty/Staff Visitor
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Lousiana College ID Number (If Applicable)
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Date
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Name
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Email Address
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Mailing Address
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Phone Number
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City State Zip Code
Section 2 – Citation Information
Citation Number: ___________________
Date Issued:_______________________
Violation: ________________________
License Tag Number: ________________
License Tag State: __________________
Officer ID #: ______________________
Location: _________________________
Section 3 – Appeal Details
The following is a complete description of the details of the case. In general, such circumstances as ignorance of the law, inability to
find a parking space, or financial hardship caused by the fines do not constitute a sufficient basis for approval of an appeal. Review the
guidelines on the next page for more information.
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I affirm the above information is true and complete.
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Signature Date
For Office Use Only
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Date Received
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By
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Date Processed
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By
(Visitors are requested to contact Security at (318) 308-6505)
***Security will not respond to a personal email account***
Permit Number:___________________
Assigned Parking Area:_____________
This form is to be taken to the Dean of Students when completed