  City of Hermosa Beach
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 Request for Administrative ReviewHERMOSA BEACH POLICE DEPARTMENT
PARKING VIOLATION ADMINISTRATIVE REVIEW PROCESS
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| Name: | ______________________ | Citation # | __________ |
| Address: | _______________________ | Date of Violation | __________ |
| City, State, Zip: | _______________________ | Time of Violation | _________ |
| Phone # | (____)____________ | Penalty Amount | _________ |
In accordance with California Vehicle Code Section 40215, you have 21 days from the date the citation was issued or 14 days from the mailing date of the Delinquent Notice of Parking Violation to submit a request for an Administrative Investigation. Please provide a written or typed statement in the space provided (attach additional sheets if necessary) as to why you feel the citation was issued in error. Include any materials (e.g. receipts, pictures, etc.) to support your claim. Materials submitted for review will not be returned.
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The results of the Administrative Investigation will be mailed to the address you provide.
FOR OFFICE USE ONLY
| Telephone | Date Requested | ____________ | Status: |
| In Person | Date Received | ____________ | Dismissed |
| Written | Results Mailed | ____________ | Upheld |
| Date Inspected | ____________ | ||
| Processor | ____________________ | Investigator |
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Sgt. Tom Thompson |