Hearing Request Form

Required fields are designated by a red asterisk (* ).

*Please indicate if citation is for a traffic, parking or animal control violation

Traffic Citation:    Parking Citation:    Animal Control Citation: 

*Please select which agency issued the citation:

Note: If your parking citation was issued by Cocoa PD,

Cocoa Beach PD, Indialantic PD, Melbourne PD or Palm Bay PD,

you must contact the issuing agency to request a hearing.

*Please enter the violation date and citation number below:

Violation Date:   Click here to display calendar      Citation Number:  

                                                                     Date format is mm/dd/yyyy                   Enter the 7 position citation number
                                                                     or click on calendar to right                   in upper case. Do not enter
                                                                     of date field to select a date.                 dashes or spaces.

If this is a traffic citation, was there an accident involved?

YES     NO