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2. Case/Ticket Number:*
   Please enter your case or ticket number
3. Hearing Date*
   Hearing Date
   Enter Hearing Date
4. Property Owners Full Name:*
   Please enter property owner full name
6. Tenant/Representative Full Name:
   Enter full name
7. E-Mail Address:*
   Enter your Email address
8. Phone Number:*
   Enter your phone number
10. Property Address in Violation*
    Property street address
11. Suite
    Suite/Apt #
13. City
14. State
15. Zip Code
17. Evidence Description:
    Please describe your evidence
19. Picture / PDF Upload
    Please upload all the supporting documents in PDF, JPG, or PNG format.
21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field