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2. City of Jacksonville Beach Request for Parking Citation Adjudication

   Citations may not be appealed after 10 calendar days.

   If you have received a parking citation that you believe was issued incorrectly or have some reason why the citation should be voided, provide your explanation in the space below. The citation will receive an administrative review. If the citation is deemed valid, you will be notified that you must pay the fine or that you can contest the citation by setting a hearing with the Clerk of Courts. Court dates can be scheduled with the Duval County Clerk of Courts. During the Adjudication process, late fees will be temporarily suspended. If you need additional information, email the Parking Division or call the division at 904-247-4004.

   Falsification of Information (In Part) F.S.S. 837.05 - whoever knowingly gives false information to any law enforcement commits a misdemeanor of the first degree.

   I do hereby certify that all information I have provided is accurate and complete. This review request form is submitted under penalty of Unsworn Falsification pursuant F.S.S. 837.05

4. Citation Number*

   Your citation number is located in the upper right corner of your citation.

6. Date of Citation
   Date of Citation

   Enter the date your citation was issued.

8. Vehicle Make

   What type of vehicle was the citation issued to.

10. Vehicle Tag Number

    What is the tag number of the vehicle issued a parking citation.

12. First Name*
14. Middle Name
16. Last Name*
18. Address*

    Include apartment numbers.

20. City, State, ZIP*
22. 1st Phone Number*
24. 2nd Phone Number
26. Email Address
28. Comments*

    Explain why you believe the citation was issued incorrectly.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field