Please complete this form if you would like to request an administrative hearing. Once we receive your request you will be notified of the date and time of your hearing via regular US mail. Hearings are typically held at the Village Hall the second Thursday of each month at 9:00am.

The fine specified on the ticket is not due at this time and does not double if your hearing request is received prior to the due date noted. No payment is necessary unless the hearing officer finds you liable for payment on the date of your hearing.

Ticket Number (CV# located in upper right hand of ticket)*

First Name*

Last Name*

Name on Ticket (if different from requestor)

Street Address*

City*

State*

Zip Code*

Phone Number

Email Address