Parking Citation Review Request Form - The Police Department - City Of Davis
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1
2CITY OF DAVIS
PARKING CITATION
REVIEW REQUEST
Date Stamp Received
Personal Information
Citation Information - Required
Name (First Last)
Citation Date
Citation#
___/___/___
Mailing Address
Apt #
___/___/___
City
State
Zip
___/___/___
Date of Birth
Drivers License #
State
Vehicle License Plate # Required
State
/
/
Day Time Phone
Alternate Phone
Parking / Disabled / Amtrak / Other Permit
(
)
(
)
Permit
EXAMPLE: HR15, XC801
A123456 (Disabled)
We may need to call you if we have any questions
Number
Facts Establishing Claim For Dismissal
-
Print Legibly or Type
(Attach additional sheets if necessary)
I certify under penalty of perjury that the above statement is true and correct to the best of my knowledge.
SIGNATURE: ___________________________________________________
DATE: ______________________
For Office use Only
ARRQ _______Date________ DISPO_______Date________ Dismissed
Denied Valid
Valid-Admin Fee
Notes:
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Parent category: Business