City Of Indio Form Ce-200 - Admin Hearing Request Form (Page 2 of 2) in pdf

City Of Indio Form Ce-200 - Admin Hearing Request Form Page 2

CITY OF INDIO V. DEFENDANT (Name):

CASE NUMBER:

DECLARATION OF FACTS (Type or print only. State what happened and explain all the items of evidence you checked in item 3

on the reverse and tell how they support your case. You may add additional pages.)

(Name):

(Current mailing address):

(Property interest):

STATEMENT OF FACTS (Begin here):

Number of pages attached: _____

I declare under penalty of perjury under the laws of the State of California that the forgoing is true and correct.

Date:

____________________________________________________

……………………………………………………………………………..

(TYPE OF PRINT NAME)

(SIGNATURE)

TO SUBMIT FORM BY MAIL:

TO SUBMIT FORM IN PERSON:

TO SUBMIT FORM BY EMAIL:

THE CITY OF INDIO

INDIO POLICE DEPARMENT

CITATION PROCESSING CENTER

46800 JACKSON STREET

P.O. BOX 7275

INDIO CA 92201

NEWPORT BEACH, CA 92658-7275

City of Indio Form

INDIO MUNICIPAL CODE, § 11.06

REQUEST FOR ADMINISTRATIVE CITATION HEARING

CE-200 [January 2016]

(Page 2 )

City Of Indio Form Ce-200 - Admin Hearing Request Form Page 2