City of Des Moines Parking Ticket Appeal

This form must be submitted within seven business days after issue date of ticket

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.

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

Questions? Contact the City Clerk's Office
400 Robert D Ray Drive, Des Moines, IA 50309-1891 (515) 283-4125

Parking Meter
Name:
Address:
City:
State:
Zip:
Daytime Telephone: ( ) -
Alternate Telephone: ( ) -
Drivers License Number:
Ticket Number:
Date Ticket Issued:
<November 2009>
SuMoTuWeThFrSa
25262728293031
1234567
891011121314
15161718192021
22232425262728
293012345
Vehicle License Number:
Vehicle Description:
Violation Type:
Handicap Permit Number:

(if applicable)


Reason for Appeal:

 (500 word maximum)

Attachment:

  (5 MB maximum)

Email Address:
Verify Email:

 A copy of the appeal will be sent to this email address.

Today's Date:

CAUTION: Any statement made on this form may constitute an admission on your part.

Signature:
 

(Type your name to serve as your signature)

If you receive a "not voided" decision, the matter may be appealed to Polk County Associate District Court for judicial determination. If you request judicial determination, you must notify the City Clerk's Office in person within seven business days of the date of the response, that you wish the complaint be filed immediately, and you must sign a promise to appear.

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