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Frank J. Lawrence NEW YORK STATE UNIVERSITY POLICE Office 518-255-5317
Chief of Police Johnson Hall
Fax 518-255-5666
ParkingAppealForm
Name&
Address
(PRINT)
Faculty/Staff Student Other
DaytimePhone CobleskillIDNo.
TicketNumber DateofTicket
PlateNumber CobleskillDecalNumber
ReasonforAppeal(attachadditionalsheetsifnecessary)
BymysignatureICERTIFYthatIamthepersoninthenameblockaboveandthatallstatementsaretrueandcomplete.
Falseormisleadingstatementsorfailuretodisclosepertinentinformationwillresultindenialofappeal.
Signature Date
DispositionbyAppealBoard
Appealaccepted,nofinecharged Appealnotaccepted,finedueintheamountof$___________
FortheBoard Date
Comments: