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NAME: <br /> <br /> CITATION NO: <br /> <br /> I hereby request a waiver of required parking penalty deposit and that the City proceed <br /> with the administrative hearing on my citation matter for the following reasons: <br /> <br /> Please complete the following: <br /> <br />1. EMPLOYMENT: 2. SUPPORTED BY: 3. PERSONS SUPPORTED: <br /> <br /> [ ] Employed [ ] Self [ ] Self <br /> [] Full-time [ ] Spouse [ ] Spouse <br /> [] Part-time [ ] Parents [ ] Children (# of) <br /> [ ] Unemployed [ ] Welfare [ ] Other <br /> [ ] Disabled [ ] S.S.I. <br /> [ ] Student [ ] A.D.C.. TOTAL__ <br /> [ ] Homemaker [ ] Unemployed <br /> [ ] Military [ ] Other <br /> [ ] Other <br /> <br />4. Your NET income (take home pay): $ every __ days. <br /> Occupation: <br /> <br /> 5. If unemployed, how long? <br /> <br /> 6. If a fine is imposed, how much could you afford to pay each month? <br /> <br /> This Request for Waiver of Parking Penalty Deposit is executed under penalty of perjury. <br /> <br /> SIGNATURE: DATE: <br /> FOR CITY USE ONLY <br /> <br /> Waiver of Deposit [ ] Granted [ ] Denied <br /> <br /> Authorized Signature Date <br /> <br />~ar~av. cf2) <br /> <br /> <br />