San Francisco State University
Citation Processing
1600 Holloway Ave.
San Francisco, CA 94132
Phone:(415) 338-7827 FAX: (415) 338-0529

To protest a citation print out this form, fill out the top half, and send it to the above address.
Don't forget to sign this form before you send it.

This is a request for a citation review only. Submittal of this request does not mean your citaion will be automatically dismissed. Your request for dismissal shall be carefully reviewed. Be certain that you explain all of the facts and any extenuating circumstances clearly and completely. Retain the original copy of the citation. You will be notified by mail of the disposition of your request.
Citation Number:_____________________

Name:_____________________________________ Telephone:_____________________

Address:___________________________________ Campus Phone: ________________

City:_______________________________ State:__________ ZIP Code:__________

Permit #:______________________ Daily Permit #:____________________

Circumstances:_________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
The above is a true and accurate account of the facts surrounding the citation, as I understand them, and my reasons for believing this citation should be dismissed.

Signature:______________________________ Date:_____________________

Date/Time Request Received:____________________ Received By:_______________________
Decal/Permit Verified:......Yes......No......N/A......
Officer's Comment:___________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

Officer's Signature:__________________________ Officer Number:_________________
Administrative Decision:
Approved ____                        Disapproved _____
___  Invited Guest                   ___  Permit not valid until after 5 PM
___  Has valid semester permit       ___  Valid permit at all times per signage
___  Had valid daily permit          ___  Permit use in non designated lot
___  Other                           ___  Other

Administrative Signature:_________________________________ Review Date:__________________