Request Form For Review Parking Violation/towing

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CITY OF NEW HAVEN
DEPARTMENT OF TRANSPORTATION, TRAFFIC &
PARKING
REQUEST FOR REVIEW
PARKING VIOLATION/TOWING
THIS FORM WILL NOT BE PROCESSED IF ILLEGIBLE OR INCOMPLETE
DATE: ___/___/___
TICKET REVIEW
TOW REVIEW
NAME: _________________________________ PHONE: _________________
ADDRESS: ______________________________________________________
CITY: ______________________________ STATE: _______ ZIP: __________
VEHICLE OWNER: ________________________ PHONE: ________________
ADDRESS: ______________________________________________________
CITY: ______________________________ STATE: _______ ZIP: __________
LICENSE PLATE NO.: ___________________
STATE: _________________
VIOLATION NO.: ___________________
TICKET NO: _________________
DATE TICKET ISSUED: ___/___/___
SHIELD NO: _________________
MAKE: _______________ YEAR: _____
MODEL: ____________________
IF TOWED, GARAGE TOWED TO: ___________________________________
NATURE OF COMPLAINT: _________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
THE FILING OF THIS FORM WITH THE DEPARTMENT OF TRAFFIC AND PARKING WITHIN 15 DAYS OF THE
ISSUANCE OF THE TICKET WILL DEFER THE ACCUMULATION OF PENALTIES ON THIS TICKET UNTIL THE
OWNER IS NOTIFIED IN WRITING OF THE RESULT OF THE REVIEW.
I HEREBY CERTIFY UNDER THE PENALTY OF FALSE STATEMENT THAT THE ABOVE
INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
SIGNATURE: ___________________________________ DATE:___/___/__
MAIL THIS FORM WITH
CITY OF NEW HAVEN PARKING VIOLATION CENTER
PARKING TICKET TO:
PO BOX 3214, Milwaukee, WI 53201-3214

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