Parking Violation Notice

PARKING VIOLATION NOTICE

Issuing Information

Issuing Authority:

Issue Date:

Location of Alleged Violation:

Time of Alleged Violation:

WHEREAS (Recitals)

WHEREAS, the Issuing Authority is vested with authority to regulate parking and enforce parking rules on the premises identified above and to notify registered owners or operators of vehicles alleged to be in violation; and

WHEREAS, the vehicle described below is alleged to have been parked in contravention of posted regulations or applicable parking rules at the time and place indicated; and

WHEREAS, this Notice constitutes written demand for payment of a civil parking fine and sets forth the administrative procedures for payment, contest, and potential collection if unpaid.

Vehicle & Owner Information

Scope of Alleged Violation

Payment Terms

Fine Amount:

Payment Due Date:

Late Fee:

Term and Termination

This Notice is effective as of Issue Date and remains in effect until the fine is paid in full, the citation is vacated by the Issuing Authority, or final administrative collection remedies have been exhausted. Start Date:

Notice Period for Appeal or Request for Administrative Review (days):

Contest / Administrative Review

To contest this Notice, check the box and provide grounds for the challenge. A timely written request for review must be received within the Notice Period above. The Issuing Authority will schedule an administrative review and provide written determination.

I elect to contest this Notice and request administrative review.

Confidentiality

The Issuing Authority shall treat personal information collected in connection with this Notice in accordance with applicable privacy laws. Information necessary to enforce this Notice, process payment, or pursue collection may be disclosed to third parties, counsel, and collection agencies as permitted by law.

By signing below, the recipient acknowledges receipt of this Notice and understands that the information provided may be used for enforcement and collection.

Governing Law; Entire Agreement

This Notice shall be governed by and construed in accordance with the laws of the state identified below without regard to conflict of law principles. Governing Law State:

This Notice, together with any attachments or schedules referenced herein, constitutes the entire written statement of the Issuing Authority's claim and remedies with respect to the parking violation and supersedes any prior oral or written communications on the same subject.

Certifications

By signing below, the Issuing Authority certifies that, to the best of its knowledge, the facts stated herein are accurate and that the procedures required by applicable parking regulations for issuance of this Notice were followed. The recipient's signature below constitutes receipt of the Notice and acknowledgement of the information contained herein.

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