Administrative Hearing Appeal Form

Name *

Citation/Case Number *

Citation Date *

Mailing Address *

Address of Violation *

Mailing – City, State, Zip Code *

Violation – City, State, Zip Code *

Phone Number *

Email Address *

Description of appellant’s legal existing interest in the property, right or entitlement of the order, citation, decision, or determination being appealed (Are you the property owner, business owner, tenant, other?) *

Brief description of the specific order, citation, decision, or determination being appealed (What are you appealing?) *

Statement of the relief sought (What are you requesting?) PLEASE NOTE- THE HEARING OFFICER IS PROHIBITED FROM REDUCING OR REVOKING A FINE PER FMC §1-409(g) *

Reasons why such relief should be granted (Why should your request be granted?) *

Will you need an interpreter at the hearing? For what language?

Estimate of the amount of time you will need to present your argument at a hearing

May they contact you by: Telephone E-Mail Mail

Please include a copy of the specific order, citation, decision, or determination being appealed. Drag and drop files here, or browse Tap to choose files PDF, photo, or Word document · up to 5 files, 10 MB each, 25 MB total

**PLEASE NOTE THAT ADDITIONAL ADMINISTRATIVE FEES FOR CODE ENFORCEMENT STAFF TIME (RE-INSPECTION AND/OR RESEARCH) MAY BE INCURRED. PLEASE REFER TO YOUR ORIGINAL NOTICES FOR MORE INFORMATION.**

I declare under penalty of perjury that the facts stated in this appeal are true of my own knowledge, except as to matters which are not within my knowledge and are not of public record, and as to those matters, I believe the facts stated to be true. * Yes

Appeal Fee

Choose the appropriate payment amount based on the type of citation appealed and the type of property that is the subject of the appeal. *

Code Enforcement

$35 for residential units up to two
$55 for three or more units
$75 for commercial units

Animal Center

$35 $50 $55 $75

Please note: Paying the wrong amount may cause your appeal to be rejected, considered late and additional fees may apply.

Your card is only charged once your appeal is successfully filed. If anything goes wrong during filing, the hold is released and you are not charged.

Card number *

Expiration *

Security code *

Billing address is the same as my mailing address

Administrative Hearing Appeal Form

Your appeal has been received