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.