HomeMy WebLinkAboutRequestForHearingBeforeTheSpecialMaster Boca
Name: ___________________________ Email: Phone:
Address:
City: _____________________________ State:________ ZIP: ____________
Your Vehicle Tag #: Tag State: _______________
City Citation #
$25 check enclosed
Yes
PLEASE STATE FACTUAL BASIS FOR APPEALING CITATION: (PRINT CLEARLY)
If more room is needed, please attach a separate paper.
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I certify that the statements made above are true and correct to the best of my knowledge and belief. I
understand that the decision of the special master is final without further right of review. Once I receive my
appeal results, whether denied or reduced, I agree to pay the amount due within fifteen (15) days after receiving
the appeal results. If payment is not received within the allotted time, a penalty of $25 may be assessed.
__________________ ________________________
Date Signature
Received by:
Parking Services Division
For additional information, please call 561-367-7048
APPEAL FOR HEARING BEFORE THE
SPECIAL MASTER
This form is to be filled out completely and accompanied by the required $25 fee.Please send the form
and check made payable to the “City of Boca Raton” to City of Boca Raton, Parking Services Division, 201
W. Palmetto Park Rd, Boca Raton, FL 33432 within 15 days from the date of citation.