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


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

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
Vehicle Model
Vehicle Year
Vehicle Color
Vehicle License Plate Number*
License Plate State*


PARKING TICKET INFORMATION


The information entered here will be used to locate and identify the parking ticket in question.
Parking Ticket Number*

Date and Time Issued
Select a date from the calendar.  

Location of Violation

Reason for Appeal*