NAME OF CONTESTANT: STREET ADDRESS: MAILING ADDRESS: TELEPHONE NUMBER: NAME OF COURT: DISTRICT NAME: ADDRESS: NAME OF PROCESSING AGENCY: ADDRESS: TELEPHONE NUMBER: FOR COURT USE ONLY COURT CASE NUMBER: NOTICE OF APPEAL - PARKING The Contestant in the above-entitled action hereby appeals to the Superior Court of California, County of Los Angeles from the final Administrative Decision on Parking Citation Number _______________, issued on _____________________. The hearing was: by personal conference by mailed declaration Date of final Administrative Decision: _____________________(a copy of the final decision must be attached) Final Administrative Decision was: personally delivered ______________________________. (Date) mailed __________________________________. (Date) Dated: ___________________ _______________________________________________ (Signature of Contestant) NOTICE TO CONTESTANT The Notice of Appeal must be filed within 30 days after personal delivery or within 35 days after mailing (Code Civ. Proc., § 1013) of the processing agency's final decision to the contestant. A SEPARATE APPEAL IS REQUIRED FOR EACH CITATION. When the Court returns a copy of this notice to you with the date, place and the time of hearing filled in, you must file a copy of the original Proof of Service of this notice with the Court at least 10 days prior to the hearing date. The Court may not proceed on your appeal if service has not been made. NOTICE OF HEARING For Court Use Only: A hearing will be heard at Los Angeles Superior Court on the date and time shown in the box below. Processing agencies are requested to mail their file to the address checked below within 15 days of receipt of this notice. DATE TIME DIV/DEPT. PLACE Central Civil, 111 North Hill Street, Los Angeles, CA 90012 SHERRI R. CARTER, Executive Officer/Clerk Dated: _____________________ DISTRIBUTION: ORIGINAL ­ Court By: ___________________________________ Deputy Clerk COPY ­ Contestant COPY - To Serve on processing Agency LACIV 005 (Rev. 09/13) LASC Approved 03-04 NOTICE OF APPEAL ­ PARKING Veh. Code, § 40230 American LegalNet, Inc. www.FormsWorkFlow.com