Initial Administrative Review Form printable pdf download

COUNTY OF LOS ANGELES

PARKING ENFORCEMENT DETAIL

INITIAL REVIEW

Respondent’s Name: _____________________________

Date Received: _______________________

Address:_______________________________________

Vehicle License Number : ______________

City:___________________ State: _____ Zip: ________

Citation Number: _____________________

Home Phone: (____) ____________________________

Business Phone: (____) _________________________

Statement of Facts: _______________________________________________________________________

________________________________________________________________

Signature:

Date:

_______________________

NOTE:

Initial Review information is accepted at the Walk-In Centers, by Telephone or by Mail. If by mail, please mail to Los Angeles

Sheriff’s Department, P.O. Box 30629, Los Angeles, CA 90030. The result of the Initial Review will be mailed to the

*****************************

address you provided.

FOR OFFICE USE ONLY

*******************************

DO NOT WRITE BELOW THIS LINE

DETERMINATION:

Liable

Not Liable

Equipment Violation-Proof of Correction. Penalty reduced to $10 per CVC section 40225(c)

*Within 21 days, mail payment to: Los A ngeles Sheriff’s Department, P.O. Box 30629 Los Angeles, CA 90030

Failure to Display Disabled Placard: Administrative Charge

CVC section 40226 - An issuing agency may, in lieu of collecting a fine for a citation for failure to display a disabled

placard, charge an administrative fee not to exceed twenty-five dollars ($25) to process cancellat ion of citation in any

ca se where the individual who received the citation can show proof that he or she had been issued a valid placard

at the time the citation was received.

No Legal Reason to Dismiss

Letter #: ______________________

DMV shows respondent as R/O when citation was issued.

DMV shows no change in ownership, there is no release of liability on file.

See attached field check/photo/DMV history.

Correct R/O: _________________________

Remarks: ____________________________________________________________________________

______________________________________________

Reviewed by:

Date: _____________________________

Rev. 12/18/14

White Copy – County

Yellow Copy – Customer

Initial Administrative Review Form

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