Name Telephone
Address Student ID
City Citation #(s)
State License Plate#
Zip SMSU Permit Color Permit #
Please Check One
Do you want to be present at the hearing?
Date of Citation
Time of Citation
Received By
Number of Unpaid Citatioins
For Review and Hearing by the Parking Appeals Committee
PARKING CITATION APPEAL
Date Appeal Received
Explain reason for appeal (attach additional sheet if more space is needed)
Location of Citation
To Be Completed by SMSU
University Parking Services Comments:
Number of Prior Citations
Comments of Committee:
Signature Date
(Payment to be made at Cashier's Window IL132)
Parking Appeals Committee Chairperson
Date
SMSU Parking Services Use Only
Date Paid _______________
Amount _______________
Date Voided _______________
Amount _______________
Student
Faculty
Staff
Guest
Other
Warning-No Fine
Citation Upheld
Fine Reduced to
Citation Dismissed
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