Parking Ticket Appeal Form

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Employer Information

Employer *

Hartford Hospital
Connecticut Children's Medical Center
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Employer (Other)

Employee Information

Name *

Department *

Phone *

Email *

Preferred means of communication *

Phone
Email

Ticket Information

Ticket Number *

Date Ticket Issued *

Location of Violation *

License Plate # *

Description of Violation

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Please fill out this form as completely as possible.
Please allow one week to process your appeal.

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Parking Ticket Appeal Form

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