| Have you registered a vehicle previous to the one currently registered? | Yes No |
| Violation notice number (located on upper right corner of violation notice): | |
| Date of violation issued (mm/dd/yyyy): | / / |
| Time of violation issued (hh:mm): | AM PM |
| Parking decal number (If you are registered with Safety, it will be located on your car window and noted on the violation): | |
| No parking decal |