Online Parking Ticket Appeal Form

All fields that have an asterisk * must be completed.

PARKING TICKET INFORMATION

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

Parking Ticket Number *

Date Issued *

Enter the date that the parking ticket was issued.

Time Issued *

Enter the 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.

Additional Documentation



Include any applicable photos or documentation for your appeal. Files must be under 6 MB.

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.

APPELLANT INFORMATION

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

Full Name *

Email *

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?
YesNo

APPELLANT LOCAL ADDRESS

Local Address

Local Address City

Local State

Local ZIP Code

Local Telephone Number