THIS AREA FOR ETEC USE ONLY
COLLEGE OF THE SEQUOIAS
DISTRICT POLICE DEPARTMENT
915 S MOONEY BLVD
VISALIA, CA 93277
BAIL RECEIVED YES____ NO___
AMOUNT OF BAIL $____________
PROCESSED BY:______________
PARKING CITATION WRITTEN DECLARATION
NAME_____________________________________________________
DATE____________________________________
ADDRESS__________________________________________________
CITATION NUMBER_______________________
CITY, STATE, ZIP:___________________________________________
VEHICLE LICENSE________________________
(
INTENT TO APPEAR AT HEARING
) I will appear in person at the hearing
(
) I will not appear at the hearing, but will be represented by this written declaration.
I,_____________________________ hereby declare the following facts in support of my request to dismiss the
above citation:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I declare under penalty of perjury, under the laws of the State of California, that the foregoing statement is true
and correct.
Executed by:________________________________ on______________
Signature
Date