Appeal Request

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Please fill out this form below and click submit. If you would like to download a hard-copy instead to print, fill out and drop-off at our office you can get it at Appeal Request.

Contact Info

Full Name
Dominion Address
Phone
Email
 

Cited for

SPEEDINGRUNNING A STOP SIGNRECKLESS DRIVINGDRIVING WITHOUT A VALID DRIVER’S LICENSEFAILURE TO STOP FOR SECURITYAUTHORIZING VISITOR TO ACCESS ANOTHER RESIDENCE OR PROPERTY
 
Date of Appeal
Date of Violation
Citation Number
 

Have you received any citations in the last 90 days?

YesNo

When was your last citation?

Are you a resident/owner?

YesNo

Are you a vendor or contractor?

YesNo

If no, are you a guest or family member?

YesNo

Reason for Appeal

 

Attach Documents

If there are any additional documents you need to submit, please upload them here.





 

Your Signature

I certify that my answers are true and complete to the best of my knowledge. Once the Security Committee reviews the appeal, I understand that my household may be subject to maximum penalties which are listed on the backside of the citation enclosed. I understand that I have the right to appeal the Committee’s decision to the Board of Directors.