Forms • Town of Christiansburg • CivicEngage

Contest of Parking Violation and Request for Court Hearing

Leave This Blank:

Complainant Information

***To be completed by citizen.***

Name:*

Street Address 1 (no P.O. Boxes):*

City:*

State:*

Zip Code:*

Telephone:*

E-mail:*

Mailing Address (if different than above):

City:

State:

Zip Code:

Complainant's Driver's License Number:*

Complainant's SSN:*

Vehicle Tag Number:*

State:*

Handicap Placard Information
(only if applicable)

Handicap Placard Number (include letters):

Handicap Placard Expiration Date:

Name Registered To Handicap Placard:

Parking Ticket Information

Please check the following parking violations you are contesting.*

	Fire Lane
	Prohibited Zone
	Yellow Line or Curb
	Fire Hydrant

	Handicapped Zone (fill out 'Handicap Placard Information' above)
	Excess 3 Hours
	Other

The parking ticket # indicated on the top of the ticket:*

If other, please list:

Date you received parking ticket:*

Location where the violation occurred:*

Please indicate the reason for contesting this violation.*

I understand that if I am found guilty, court costs may be imposed in addition to the fine(s). A fee will be imposed for failure to appear in court in addition to the fine(s) and court fees.*

Date:*

* indicates required fields.

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