OHSU - Parking: A p p e a l F o r m

Parking Ticket - Appeal Form
	Please fill out this form completely. Incomplete appeals cannot be processed. When finished - please print this form and mail it with a copy of your citation to the below address. OHSU Transportation & Parking Attn: Parking Ticket Appeals 3310 SW US Veteran's Hospital Rd Portland, OR 97239 Campus Mail Code: PP233 You will be notified if your citation appeal has been approved, denied or the amount reduced.

	Vehicle License No.	State:
...	First Name:
...	Last Name:

...	Local Address:
...	City:	..State: Zip:
...	Ticket Number:
...	Ticket Date:
...	Day Phone:
	Date of Submittal:

	Appeal Information
...	Reduced fines for OHSU employees can be deducted from the violators paycheck at the employee's request. Failure to pay any reduced fine within 30 days will result in a doubling of the original fine. All rules and regulations are administered by the policies set forth by the OHSU Parking Committee. Email Response check here If you would prefer the response of our decision be sent via email - otherwise, notification will be sent to the address provided above. email address:
	I am a:StudentStaffVisitorPatientVolunteerContractor
	Please type in the space below your appeal: Note: Maximum charactures is 250. If you would like to write a longer description, please print out seperately and fax or send it campus mail with your appeal.

	- - - - - - - - - - - - - - - - - - - FOR OFFICE USE ONLY - - - - - - - - - - - - - - -
	Your parking ticket appeal has been :.. DENIED $: ............REDUCED TO $: ............WAIVED $: ............TOTAL AMOUNT DUE:...................
	In case of denied petition, you may appeal within ten days to the OHSU Parking Committee.. Fines are due and payable to the above within 30 days. If error or questions, call (503)494 - 8283. or Fax number (503) 418 -1299.