You are on page 1 of 1. There are 26 questions to answer on this page.

All fields that have a red * must be completed.

APPELLANT INFORMATION

The name and email address of the person appealing the parking ticket should be entered here.

First Name*
Middle Name
Last Name*
E-Mail
The email address will be used for follow-up contact by Kutztown Borough Police Department personnel. This address will not be used to notify the appellant of the decision on the appeal. Appeal decisions will be sent via US Mail. This email will not be released outside of this agency.

APPELLANT HOME ADDRESS


Some individuals receiving parking tickets may live at a different address during certain parts of the year. It is important to list both addresses in this case as this information may be used to contact the appellant and also to verify vehicle ownership.

When it is necessary to contact the appellant directly, the Kutztown Borough Police Department will attempt to contact the appellant using the LOCAL ADDRESS information first if that information was provided.

Address*

City*
State/Province*
ZIP/Postal Code*
Primary Phone*
Other Phone
If you have another telephone number that you can be contacted at such as a cellular telephone, please list it here.

SEASONAL RESIDENCY
Home Address Same as Local Address?

APPELLANT LOCAL ADDRESS
Local Address
Local Address City
Local State
Local Zip Code
Local Telephone Number*


VEHICLE INFORMATION


Information on the ticketed vehicle should be entered here. This information will be used to verify the information on the parking ticket.
Vehicle Make
Enter the full name of the manufacturer of the vehicle ticketed; EX: Chevrolet, Ford, Saab, etc.
Vehicle Model
Enter the model of the vehicle ticketed; EX: Taurus, Blazer, etc.
Vehicle Year
Enter the model year of the vehicle ticketed.
Vehicle Color
Vehicle License Plate Number*
Enter the license plate number of the vehicle ticketed.
License Plate State*
Enter the state that the vehicle is registered in; EX: PA, NJ, CT, etc.

PARKING TICKET INFORMATION


The information entered here will be used to locate and identify the parking ticket in question.
Parking Ticket Number*
Enter the entire number printed in red on the upper right hand corner of the front of the ticket.
Date and Time Issued
Select a date from the calendar.  
Enter the date and time that the parking ticket was issued
Location of Violation
Enter the location of the violation as it appears on the parking ticket.
Reason for Appeal*
Indicate in detail as to why you feel the parking ticket was unwarranted or issued in error. Claims of the vehicle being disabled will require verification in the form of documentation such as an invoice or receipt for repair.