UConn Health Parking Citation Appeal Form Contact and Vehicle Registration InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail* Name of Registered Owner* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Reason for Parking on CampusSelect one:*ContractorEmeritus/RetireeEmployee Area 1Employee Area 3Patient/VisitorResident/FellowStudentVolunteerPermit Number (if applicable)DMV Handicap Permit Number (if applicable)Ticket and Vehicle InformationTicket Number*Date Issued* MM DD YYYY Type of Violation*Choose one:Improper display of permit: $25.00Violation of posted sign: $30.00Load zone violation: $30.00Double parked/more than one space: $30.00No University permit/decal: $30.00No parking area: $30.00Out of marked space: $30.00In or blocking lot aisle/entrance: $30.00In an unassigned area: $30.00Misuse of electric vehicle charging or low emission vehicle space: $30.00On a sidewalk, lawn, unpaved area: $50.00Using a forged or altered permit: $50.00In a bus stop: $50.00Blocking entrance/exit to building: $50.00In a fire lane: $50.00Within 10 feet of a fire hydrant: $50.00Parking permit revoked: $50.00Parking in excess of 24 hours: $50.00Parking in a reserved area: $50.00 (Note: reserved parking designations are enforced on all business days, including the six minor holidays.)In a handicap space: $150.00Misuse of handicap permit: $150.00Vehicle License Plate Number*State License Plate Issued* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Parking Location*Choose one:Garage 1Garage 2Garage 3Lot A1Lot A2Lot A3Lot A4Lot A5Lot A6Lot M1Lot M2Lot H1Lot L1Lot L2Lot L3Lot L4Lot L5Lot L6Lot MR1Lot MR2Lot MR3Lot MR4Lot MR5Circle RoadMain RoadWest RoadDowling WayASB MSI Loading DockEast Loading DockOutpatient Pavilion Loading DockWest Loading DockAcademic EntranceMain Building EntranceMunson Road EntranceOutpatient Pavilion EntranceUniversity Tower Entrance195 Farmington AvenueCell and Genome Sciences BuildingWarehouseReason for AppealPlease describe the reason for your appeal.*Copy of Citation