SECTION 1
Name: ___________________________________________________________________
(First) (MI) (Last)
Address: _________________________________________________________________
(Street) (City) (State) (Zip
Code)
Check Appropriate Line
____ I request to appear in person before a Hearing Officer
____ I request to have my hearing conducted based on a written statement
and all
relevant documents
are attached
Relationship to Vehicle (circle one): Registered Owner Driver Leasee
Citation Number: ___________________ Vehicle License Number: _______________
Issuing Agency: City
of Salinas, 200 Lincoln Avenue, Salinas, CA 93901
SECTION 2
The above entitled matter was heard on _________________________ Time__________
Location of Hearing: West Wing Conference Room, City of Salinas, 200 Lincoln Avenue, Salinas, CA 93901
Hearing Examiner: Appointed
by the Conflict Resolution and Mediation Center Of Monterey County
SECTION 3
Disposition: ___ LIABLE
___ DIMISSED
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Hearing Examiner’s Signature _____________________________________
SECTION 4
Continuation: The respondent has provided evidence/reason to
be granted a continuation
until____\_____\____at _________p.m. / a.m.
Return form and all relevant documents to:
Finance Department
City of Salinas
200 Lincoln Ave.
Salinas, CA 93901