UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE

FORM NUMBER:      FORM 0058 PITT 5010

FORM TITLE:            Parking Violation Appeal

PROCEDURE:           04-03-01

EFFECTIVE DATE:   July 1998

PAGE (S):                   1

TO BE COMPLETED BY PERSON APPEALING A UNIVERSITY OF PITTSBURGH

PARKING VIOLATION

Enter the following information where indicated:

1.    Name of appellant (Last, First, MI).

2.    Date the appeal is filed in the Parking Office (no more than 10 days from the time the

       parking violation was issued).

3.    Social security number of appellant (NNN-NN-NNNN).

4.    License plate number.

5.    Work address where appellant can be contacted.

6.    Work telephone number.

7.    Home address of appellant.

8.    Home telephone number.

9.    Email address.

10.  Check yes or no to indicate if you hold a University Permit.

11.  University parking permit number.

12.  Check type of University classification.

Provide the following information from the Parking Violation:

13.  Type of violation.

14.  Number of ticket from upper right hand corner of Parking Violation.

15.  Date ticket was issued.

16.  Name of issuing Officer.

17.  Location of violation.

18.  Time ticket was issued.

Reason for Appeal:

19.  In the space provided, state reason for appeal.