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Parking Ticket Mediation Request

  1. Ticket Number

  2. This form is being provided to you for the purpose of communicating with the officer who issued this ticket and his or her supervisor. It is designed for situations where you had limited or no communication with the officer who issued the ticket. Completion of this form does not relieve you of any fines or penalties associated with this ticket. MEDIATION IS NO LONGER POSSIBLE AFTER THE DUE DATE ON YOUR DELINQUENT NOTICE.

  3. Leave This Blank:

  4. This field is not part of the form submission.