City of Cedar Hills

Parking Citation Appeal Form

Notice: All persons receiving a parking citation have a right to appeal within fourteen (14) calendar days from the date of the citation. To file an appeal, fill out applicable fields and sign and submit below. An administrative fee of $20 is required. This fee will be refunded to the appellant if the citation is reversed. All decisions by the arbitrator are final.

Phone Number

Citation Number

License Plate Number

State of License Plate

Reason for Appeal: Describe why you believe the arbitrator should reverse the decision of the zoning officer.

Sign Here

First Name

Last Name

Choose how to sign

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

An administrative fee of $20 is required. This fee will be refunded to the appellant if the citation is reversed. All decisions by the arbitrator are final.

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	Parking Citation Appeal Administrative Fee	20.00
Subtotal

Card Holder Name *

Credit Card Number *

Security Code *

Exp Month *

Exp Year *

City of Cedar Hills • 10246 N Canyon Road • Cedar Hills, Utah 84062 • Phone (801) 785-9668, ext. 204 FAX (801-796-3543 • Email: ssampson@cedarhills.org • www.cedarhillsutah.gov

CHZ007, 08-16-2016