To ensure proper recording of your payment, it is strongly recommended that you complete all requested fields on this form.

CONTACT INFORMATION:

First Namerequired

Last Namerequired

Name of Student Driver

(if different than above)

Cell Phonerequired

Email Addressrequired

VEHICLE INFORMATION:

Citation Numberrequired

Number appears in red in the upper right-hand corner of the citation.

Vehicle Makerequired

Vehicle Modelrequired

Vehicle Colorrequired

Vehicle Yearrequired

License Plate Numberrequired

License Plate Staterequired

JSerra Parking Permit #

(if applicable)

VIN

VIOLATION INFORMATION:

Date of violationrequired (mm/dd/yyyy)

Time of Violationrequired

Location of Violationrequired

Name of Officer

Reason for Citation*

Please indicate the specific violation as noted on the citation.

Double Parked Prohibited Area Fire Lane Restricted Zone Parked in Handicapped Obstructing Traffic Lane No Parking Permit No Permit Displayed Other

"Other" Violationrequired

Enter the specific details of the violation as noted on the citation.

Amount of Fine*

Select the correct amount as noted on the citation.

$25.00 $40.00 $50.00

TOTAL DUE:required