APPEAL OF PARKING VIOLATION (S)

INDIANA UNIVERSITY SOUTH BEND

TICKET NUMBER (S)

DATE OF APPEAL ______________

Please check if you wish to appear at the Appeals Meeting in person. YES NO

If you choose not to appear, your appeal will be read as written to the committee.

Please explain reason for appeal below.

Make sure your explanation is as clear as possible.

The decision of the Appeals Committee is FINAL.

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ID# Address

_________________________________ _____________________________________

Name (Print)

_________________________________ _____________________________________
Telephone E-mail

OFFICE USE ONLY

Entered in computer___________________ Date notified of meeting _________________

Appeals Committee decision: Denied _____________________ Granted _____________________