Parking Ticket Violation Appeal Form

I request a hearing before the Parking Appeals Adjudicator in response to the
summons described below:

Last Name:


First Name:


Summons Number:


Date of Summons (mm/dd/yyyy):
*Appeal must be sumbmitted within five (5) business days of the summons date.


Time of Summons (hh:mm):


Location:


Alleged Offense:


Check relationship to SUNY Geneseo:
Faculty/Staff
Resident Student
Commuter Student
Graduate Student
Visitor/Guest
Contractor/Vendor
Emeriti
Other:

Appeal Basis:

Supporting documentation such as statements from witnesses, photographs, receipts, or other
information that supports your appeal must be provided to the Parking Services Office, located
in Schrader Room 19, prior to the appeal hearing.




Check a meeting option:
Meet with the Appeals Adjudicator - time and place will be emailed to you.
Submit as a written appeal.


I understand that false or misleading statements or failure to disclose pertinent information may
result in the denial of appeal. It may also result in the loss of special permit privileges and/or other
appropriate administrative action.
Mailing Address or C.U. Box Number:


Email Address:


Phone Number (with area code):



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FOR OFFICE USE ONLY

________Appeal Granted

________Appeal Denied

________Appeal Denied Fine Reduced to $_________


Reason/Comments:

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_________________________________________________________________________________________
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Signature of Adjudication Officer:

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