Ticket Appeal Form
Department of Public Safety
Parking Services
306 Broad Street
Warrensburg MO, 64093
(660)-543-4098
*All fields required
Name: ___________________________________________________________________________
Email Address for Appeal Response: __________________________________________________
Mailing Address: ___________________________________________________________________
Street Apt. # City, State, and Zip Code
Student/Employee 700#:______________ Phone Number: ________________________________
Cell Home
Ticket Number: _________________ Time of Ticket: ______________ Date of Ticket: ___________
Permit Number Displayed (if any):______________ Issued by: ________ License Plate: __________
Violation Description: ___________________________Lot Number: ________State: ____________
Reason for Appeal:
This Section is for Parking Services Office Use Only:
Officer Response: _________________________________________________________________
_______________________________________________________________________________
Parking Services Comments: ________________________________________________________
________________________________________________________________________________
Permit Number: __________Valid Permit for Date of Ticket: __________Date Verified: ___________
Total Number of Tickets for this Academic Year: _____________
Total Number of Tickets Warned this Academic Year: ____________ Initials: ____________
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