Town of Occoquan | Parking Citation Contest Request
Use this form to submit a written request to contest a Town of Occoquan parking citation. Requests must be submitted within 10 business days of the notice of violation. Submission of this form does not guarantee acceptance if the request is late or incomplete. The Town Clerk or designated staff will review your request and contact you with next steps.
Request Type and Contact Information
1. Are you requesting to contest a Town of Occoquan parking citation?
*
Yes
No
2. Full Legal Name
*
3. Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
5. Email Address
*
example@example.com
Citation Information
6. Notice of Violation Number
7. Date of Violation
-
Month
-
Day
Year
Date
8. Was the cited person under the age of 18 on the date of violation?
*
Yes
No
Guardian Questions
9. Parent/Guardian Full Name
*
10. Parent/Guardian Phone Number
*
11. Parent/Guardian Email Address
*
Contest Statement and Certification
12. Please explain why you are contesting this citation.
*
13. Vehicle Plate Number
*
14. State of Plate
*
15. Supporting Documentation
Browse Files
Drag and drop files here
Choose a file
Please upload any documentation or proof of compliance with the law.
Cancel
of
16a. Certification
*
I certify the information I submitted is true and correct to the best of my knowledge
16b. Certification
*
I understand this form is a written request to contest my parking citation
16c. Certification
*
I understand that late or incomplete requests may not be accepted.
17. Signature
*
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