Issuing/Processing Agency: Sierra College Police Services, 5000 Rocklin Road, Rocklin, CA 95677, Phone (916) 781-0570
If you are dissatisfied with the results of the Initial Review of a notice of parking violation and wish to request an Administrative Hearing, complete this form and return it to the Issuing/Processing Agency along with a deposit for the full amount of the parking penalty shown on the notice of violation. An Administrative Hearing will be scheduled within 90 days. Parking penalty must be deposited before a hearing will be scheduled unless a Declaration of Financial Hardship (Publication SCP104) has been submitted and approved. Deposit will be refunded if found not liable. For complete information about contesting a notice of parking violation refer to Publication SCP101 entitled Contesting a Notice of Parking Violation: Procedure.
| NAME & ADDRESS (MAILING LABEL - PRINT NEATLY) _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ |
TODAY’S DATE | |
| DATE CITATION ISSUED | ||
| CITATION NUMBER
|
VEHICLE LICENSE PLATE | PENALTY AMOUNT |
Check one box below, for method of payment of deposit.
| CHECK or MONEY ORDER enclosed. |
| Charge to VISA. |
| Charge to MASTERCARD. |
CREDIT CARD NUMBER ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ EXPIRATION MM/YY ___ ___ / ___ ___ NAME ON CARD _____________________________________________ AUTHORIZED SIGNATURE ______________________________________________________________________ |
| Unable to pay due to financial hardship. (Attach Declaration of Financial Hardship.) |