Santa Clara — CV-5041*

Source: https://santaclara.courts.ca.gov/system/files/forms/cv-5041_rem.pdf

ATTACHMENT CV-5041 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar No., and Address): FOR COURT USE ONLY

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TELEPHONE NUMBER: FAX NUMBER: please press the Reset Form button at the end of this form ATTORNEY FOR (Name): when finished. SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: 191 North First Street CITY AND ZIP CODE: San José, California 95113 PHONE NUMBER: (408) 882-2100 BRANCH NAME: Downtown Courthouse, Civil Division

PLAINTIFF (Processing Agency):

DEFENDANT (Appellant):

CASE NUMBER:

NOTICE OF PARKING/ADMINISTRATIVE APPEAL

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 gives notice of the time 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:

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(TYPE OR PRINT NAME) (SIGNATURE OF APPELLANT)

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CV-5041 8/01/05 NOTICE OF PARKING/ADMINISTRATIVE APPEAL Page 1 of 1