ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 APPELLANT: NAME: ADDRESS: SSN: _______ - ______ - ________ DLN: ISSUING AGENCY: CASE NUMBER: NOTICE OF APPEAL - PARKING As the appellant in the above entitled action, I hereby appeal the final administrative decision on parking citation no. ____________________ which was originally issued by the above agency on _____________________________. The hearing was: Personal Conference Decision Rendered by Mail Date of mailing of final decision by issuing agency: ________________________________. MANDATORY REQUIREMENTS • This Notice of Appeal must be filed with the Court within 30 days the mailing of the final decision by the issuing agency; • A filing fee of $25.00 must be deposited with the Court at the time of filing; • No later than 10 days prior to the de novo hearing (see date below), you must file proof of service with this Court that the issuing agency was served with this Notice of Appeal; and • Failure to comply with each of these requirements may result in the dismissal of your appeal or denial of a de novo hearing. I declare under penalty of perjury that the foregoing is true and correct. Date: ____________________________________ SIGNATURE OF APPELLANT A hearing will be conducted at the Marin County Superior Court, Hall of Justice, San Rafael, California, on the date and time indicated below: DATE TIME AM / PM KIM TURNER Court Executive Officer Date: ___________________________________ By: DEPUTY Upon receipt of this Notice of Administrative Appeal, the local agency shall be responsible for sending the complete file to The Marin County Superior Court within 15 days. CV029WB NOTICE OF APPEAL - PARKING Rev. 7/07 American LegalNet, Inc. www.FormsWorkflow.com