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Parking Violation Appeal Form

2. Applicant Information

4. Name*

5. Email Address

   Include your email if you would like to be emailed of your appeal decision.

7. Address*

9. City*

10. State*

11. Zip Code*

13. Phone Number*

15. License Plate*

16. State of Registration*

17. File Upload (if applicable)

    You may upload supporting documents

19. 10 digit Violation Number *

    This number appears on your ticket.

21. To the Parking Clerk of the City of Gardner, In accordance with MGL Chapter 90, Section 20A½-20E, I hereby appeal the above numbered alleged parking violation in the City of Gardner. After carefully considering the facts relating to this violation, I believe I have fair and just reason to appeal and obtain cancellation. I understand that if I am not satisfied with the Parking Clerk’s response, I will be assigned a date and time for a formal hearing to present new information only.

23. REASON(S) FOR APPEAL *

25. TERMS OF ACCEPTANCE and SIGNATURE

27. I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.*

    Please type your first and last name

28. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*

    1. I Agree

30. Your form information is now complete. Please click on the Submit button below to have this form sent to the Parking Enforcement Official.

34. Your appeal has been reviewed. You are hereby advised:

    1. To pay the violation fee within ten (10) days of issuance of this notice. Failure to comply in a timely manner will result in additional penalties (up to $35.00) being added to the origin
    2. You have been found to be in violation of City parking regulations, but your penalty is waived. All future violations will stand.
    3. Based upon evidence provided, your appeal has been approved, no further action is required.

35. Fee Amount

37. Explanation

39. Parking Clerk Signature

43. Amount Due:

44. Amount Due By
    Amount Due By

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field