Parking Ticket Appeal Form

(File in the Des Moines City Clerk’s Office within seven business days after the issue date of the ticket)

If you do not receive a response within 30 days, please contact the City Clerk's Office at 515-283-4125

This is an administrative review process. Please complete this form if you believe the parking ticket received by you is unwarranted because the facts alleged on the ticket fail to show an ordinance was violated or the parking meter was inoperable and you reported it within 24 hours after issue of the ticket. An administrative review panel will consider the matter and make a determination on the merits of your case. Be complete and include any documentation and/or diagrams, as this is the only evidence that will be considered by the review panel. A copy of the panel’s decision will be mailed to you.

Questions? Contact the City Clerk’s Office at 515-283-4125

Please print or type

NAME

 

  
ADDRESS

 

  
CITY, ST, ZIP

 

  
Daytime Phone Number

 

  
Alternate Daytime Phone Number

 

  
Drivers License Number

 

  
Ticket Number

 

  
Date Ticket Issued

 

  
License Plate Number

 

  
Vehicle Description (make, model, color)

 

  

Violation Type (Check One)

___Overtime

___Illegal

___Handicapped     (State Issued Permit # if applicable)  ________________________

REASON FOR APPEAL:

Please attach any diagrams or photographs you would like to be considered.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Caution, any statement made on this form may constitute an admission on your part.

Submit form to City Clerk’s Office, 400 Robert D. Ray Drive, Des Moines, IA 50309, or Fax to 515-237-1645.

 

Signature___________________________________

Today's Date_________________________________

If you receive a "not voided" decision, the matter may be appealed to the Polk County Associate District Court for judicial determination.  If you request judicial determination, you must appear at the City Clerk's Office within seven business days of the date of the response, You must sign a promise to appear.