Fill and Sign the City Drivers from These Gentrifying Areas Get the Most Ppa Tickets Form

Date Defendant or Corporate Officer Signature 1. Sign here 2. Mark (''X'') your plea below: Home Phone Street Current ADMITTED Mailing NO CONTEST Work Phone City, State, Zip Address DENIED (state reason below) Date Signature Parent or Deliver your plea in person or by mail to the District Court for the county in which you received the ticket and the Municipality listed below. Guardian of Home Phone Street Defendant Under 18 Years of Age IF YOU FAIL TO DELIVER A PLEA WITHIN 20 DAYS: Judgment will be entered against you by default, and you will be liable for the FINE AMOUNT. IF YOU PLEAD DENIED: Mark your plea, sign and state your reason why above. Deliver your plea to the District Court within 20 days. You will be scheduled to appear in court. If you plead DENIED, state your reason why: ____________________________________ ____________________________________ ____________________________________ ____________________________________ City, State, Zip Work Phone IF YOU PLEAD ADMITTED OR NO CONTEST: Mark your plea and sign above. Deliver your plea to the District Court and the Municipality within 20 days with payment of the FINE AMOUNT shown on the front of the Complaint. Pay by check or money order in U.S. funds, make checks payable to: VT DISTRICT COURT. Judgment will be entered against you. ADDISON DISTRICT COURT 7 Mahady Court Middlebury, VT 05753 BENNINGTON DISTRICT COURT 200 Veterans Memorial Drive Bennington, VT 05201 CALEDONIA DISTRICT COURT 1126 Main St · Suite 1 St. Johnsbury, VT 05819-2694 CHITTENDEN DISTRICT COURT 32 Cherry Street, Suite 300 Burlington, VT 05401 ESSEX DISTRICT COURT P.O. Box 75 Guildhall, VT 05905 FRANKLIN DISTRICT COURT 36 Lake Street St. Albans, VT 05478 GRAND ISLE DISTRICT COURT P.O. Box 7 North Hero, VT 05474 LAMOILLE DISTRICT COURT P.O. Box 489 Hyde Park, VT 05655-0489 ORANGE DISTRICT COURT 5 Court St. Chelsea, VT 05038 ORLEANS DISTRICT COURT 217 Main Street Newport, VT 05855 RUTLAND DISTRICT COURT 9 Merchants Row Rutland, VT 05701-2836 WASHINGTON DISTRICT COURT 255 North Main Street Barre, VT 05641 WINDHAM DISTRICT COURT 30 Putney Road, Suite 2 Brattleboro, VT 05301 WINDSOR DISTRICT COURT 82 Railroad Row White River Junction, VT 05001 Form #427 PARKING VIOLATION COMPLAINT 6/06 SML Municipal No. Plaintiff Municipality (please print) First Middle Initial Mailing Address: Street City Violation Date Time Defendant's Last or Organization Name Date of Birth Corp/Organization M F Defendant's vehicle was issued parking ticket # Location of Violation Vehicle Make Vehicle Model Vehicle Color Defendant did then and there commit the following acts: Defendant contested the parking violation pursuant to the municipal procedure. Defendants' appeal was denied. Defendant exhausted the procedure provided and has not paid the fine assessed for the violation. Registration State Registration # Distribution List: Original file with District Court; 1 copy to Municipal Atty. or Responsible Official; 1 copy to Defendant to retain for their records; 1 copy to Defendant to return to District Court; 1 copy to Defendant to return to Municipality FINE AMOUNT $ In Violation of Municipal Ordinance: Date Served In Hand U.S. Mail Municipal Atty. or Responsible Official (printed) Responsible Official Title Parent or Guardian Last Name Street Address Zip Code First Name City State Municipal Atty. or Responsible Official signature Servicemembers' Civil Relief Act Affidavit Under oath, I state Defendant is NOT on active duty in the U.S. armed forces because: Defendant said he/she is not on active duty in the U.S. armed forces. Defendant is under 17 years of age. Other: Officer Signature: State of Vermont, Subscribed and sworn before me: Date: County: Notary: Pursuant to 4 V.S.A. § 437(11) and 24 V.S.A. § 1974a(e). Business Phone Home Phone Delivered To (Def., Reg. Agent, or Corp. Officer) Zip Code State MUNICIPALITY ADDRESS: by . ( ) - ( ) - - - - - - - - - - - - - - - - -