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2. PLEASE READ

   Should you choose not to  pay the fine, you may request, within 10 business days of the citation an Administrative Code Enforcement Hearing with the office of the Administrative Law Judge.

   If you do not request a hearing within 10 business days of the citation date, the citation may become a final order from the Administrative Law Judge and will be levied against the person named on this citation. Failure to comply with the citation may result in additional fines and charges.

4. Case #:*
5. Citation #:
6. Date Citation Served by Officer*
   Date Citation Served by Officer
8. Defendant Name:*
9. Phone:*
11. Mailing Address:*
13. City:*
14. State:
15. Zip:
17. Email:*
18. Address of Violation:*
20. Description of Appeal:*
22. Upload any evidence for the court:
    The form is set for one file. If you have more than one file, such as multiple pictures, please combine into a single zip file or other method. Acceptable formats include, .jpg, .pdf, .docx, .doc, .mp4, .wav, .mov.
23. Special requests
    Any special requests or accommodations that the court needs to be aware of:
25. Provide your name to agree to appear.*
    I hereby request an Administrative Law Judge hearing with Summit County. Summit County will provide a 7 day prior notification of the hearing. Administrative Law Judge Hearings will be scheduled as needed. Hearing will be heard at the County Courthouse, 60 N Main St. Coalville UT 84017.
26. Today's date*
    Today's date
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

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