ATTORNEY OR PARTY WITHOUT AN ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: ATTORNEY FOR (Name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA BRANCH NAME: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: PHONE NUMBER: OFFICE HOURS: DOWNTOWN SUPERIOR COURT, CIVIL DIVISION 191 NORTH FIRST STREET 191 NORTH FIRST STREET SAN JOSE, CA 95113 (408) 882-2100 MONDAY ­ FRIDAY 8:30 AM ­ 4:00 PM WWW.SCCSUPERIORCOURT.ORG PLAINTIFF: (Processing Agency) DEFENDANT: (Appellant) NOTICE OF PARKING/ADMINISTRATIVE APPEAL CASE NUMBER: This is a Notice of Appeal of the decision of the hearing officer in the matter of parking citation number _________________________________________. This appeal is filed pursuant to California Vehicle Code (CVC) § 40230. Appellant attaches a copy of the hearing officer's decision and requests that: 1. The Clerk of the Court set the matter for hearing before the above-entitled court, where it will be heard in accordance with CVC § 40230 and CVC § 40215. 2. The Clerk of the Court give notice of the time, date, and place of the trial to each of the parties. Appellant certifies that a copy of this Notice of Parking/Administrative Appeal has been mailed to the Processing Agency at the address shown below: Date: __________________________________________ ___________________________________________ (TYPE OR PRINT NAME) (SIGNATURE OF APPELLANT) Superior Court of California County of Santa Clara CV-5041 [New August 1, 2005] NOTICE OF PARKING/ADMINISTRATIVE APPEAL Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com