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2. 40U Appeals Application
3. 
5. Violation Information
7. Address*
9. City*
10. State*
11. Zip Code*
13. Violation Number*
14. Date of Violation*
16. Contact Information
18. Name*
20. Email*
22. Phone Number*
24. Address (If different from property address)
26. City
27. State
28. Zip Code
30. Appeal Request
32. Has a Cease-and-Desist Order, Order to Correct, or Notice of Violation been issued aganst the propery?*

    1. Yes
    2. No
34. Do you wish to delegate someone else to appeal this ticket on your behalf?

    1. Yes
36. Name of Person Appealing Ticket on Your Behalf
38. Phone Number of Person Appealing on Your Behalf
40. Email of Person Appealing on Your Behalf
42. Address of Person Appealing on Your Behalf
44. City
45. State
46. Zip Code
48. 1. Click here to signify your electronic signature
50. Please Print Name*
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field