Form Center

2. Name*
3. Ticket Number*
5. Address*
6. Date of violation*
8. City, State, Zip Code*
9. Phone Number*
11. Email Address*
13. In accordance with applicable town ordinances, you have 21 days from the date the violation was issued to submit this request for review of an ordinance violation. Please provide a written or typed statement in the space provided (attach additional sheets if necessary) as to why you feel the violation was issued in error. Materials submitted for review will not be returned.*
15. Should you need to upload a photograph, you can do that here:
17. Please check one of the following options:*

    1. I request a formal hearing on this matter.
    2. I DO NOT request a formal hearing on this matter.
19. Signature*
20. Date submitted*
22. Driver's license #
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field