Fillable Mt. San Jacinto College Campus Safety Department (Mt. San Jacinto Community College District)

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Mt. San Jacinto College Campus Safety Department (Mt. San Jacinto Community College District)

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Mt. San Jacinto College
Campus Safety Department
San Jacinto Campus Menifee Campus
1499 N State Street, Rm. 750 28237 La Piedra Rd., Rm.1804
San Jacinto, CA 92583 Menifee, CA 92584
(951) 487-3182 (951) 487-3182
PARKING TICKET APPEAL FORM
Ticket #: __________________
Violation #: __________________
Issue Date: __________________
Student ID #: __________________
Officer: __________________
License Plate#:________________________ Color: ____________________
PLEASE PRINT LEGIBLY
NAME:________________________________________________________________
ADDRESS:_____________________________________________________________
PHONE:_______________________________________________________________
EMAIL ADDRESS:______________________________________________________
REASON FOR PROTEST:________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Use reverse side if more space is needed)
APPELLANT SIGNATURE: ______________________________________
DATE: ___________________________
ISSUING OFFICER’S REVIEW
PROTEST IS VALID __________ PROTEST IS NOT VALID ____________
CAMPUS SAFETY OFFICER COMMENTS:________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Officer Signature: ___________________________ Date: ___________________
click to sign
signature
click to edit
Supervisor Comments: ___________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
__________ APPEAL IS VALID (Citation is dismissed)
__________ APPEAL IS NOT VALID (Citation is upheld)
Supervisor Name: _____________________________________
Supervisor Signature: __________________________ Date: __________________
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Mt. San Jacinto College Campus Safety Department (Mt. San Jacinto Community College District)

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Completed 5 September 2020

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