*Last Name:      *First Name:     

*Local Address:     

*City:      *Zip:     

*Home Phone:      Work Phone:

*MWSU ID # :      *Email:     

*Vehicle License/State:      Sticker #:     

*Citation #:      *Date Issued:      *Time Issued:     

*Officer #:      *Offense Location:     

*Reason for Appeal:

A $10.00 ADMINISTRATIVE APPEAL FEE MAY BE ADDED TO YOUR PARKING FINE FOR ALL APPEALS THAT ARE UPHELD BY THE TRAFFIC APPEALS BOARD.

You will receive a confirmation receipt of your Appeal Form by email.

Your confirmation receipt will include your Appeal Hearing date and time.

By clicking "Submit", I understand that there is a possible $10.00 per citation fee for all upheld citations.