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2. Applicant Information
4. Name*
5. Email Address*

   Your appeal decision will be emailed to you.

7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. License Plate*
16. State of Registration*
17. File Upload (if applicable)
    You may upload supporting documents
19. Violation Number *

    This number appears on your ticket.

21. To the Parking Clerk of the City of Gardner, In accordance with MGL Chapter 90, Section 20A½-20E, I hereby appeal the above numbered alleged parking violation in the City of Gardner. After carefully considering the facts relating to this violation, I believe I have fair and just reason to appeal and obtain cancellation. I understand that if I am not satisfied with the Parking Clerk’s response, I will be assigned a date and time for a formal hearing to present new information only.
23. REASON(S) FOR APPEAL *
25. TERMS OF ACCEPTANCE and SIGNATURE
27. I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.*
    Please type your first and last name
28. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*

    1. I Agree
30. Your form information is now complete. Please click on the Submit button below to have this form sent to the Parking Enforcement Official.
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40. 1. Receive an email copy of this form.
41. Email address

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42. Submit Submit and Print

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