CITY OF FORT BRAGG
FOR CITY OFFICE USE ONLY:
NOTICE OF APPEAL OF CITATION
Citation No.: Violation No.: Citation Issuance Date:
RESPONSIBLE PARTY INFORMATION
Name: Phone: Email:
REASONS FOR CONTESTING CITATION
�I, as the Responsible Party or authorized Representative of the Responsible Party, understand that failure to submit a completed Notice of Appeal of Citation Form within the alloted timeframe may have my appeal and request for hearing denied by the City Clerk, and that if notified by the City that my appeal request is rejected due to being incomplete, invalid or untimely does not extend the time in which I have to appeal the associated citation.
Signature of Responsible Party or Representative of Responsible Party:
Date:
If submitting form by mail,
please send to:
City of Fort Bragg
416 N. Franklin St.
Fort Bragg, CA 95437
ATTN: City Clerk
If you would like more
information on the Hearing
Process, contact the City at
(707) 961-2826 or email
[email protected].
Stamp of Receipt:
For City of Fort Bragg Office Use Only
RESPONSIBLE PARTY: File # ____________________
Date Filed ________________
Received by _______________
Request: Approved Denied
Date of Hearing __________