Parking Citation Appeals must be submitted within 15 calendar days of the date printed on the front of the citation. 

Complete and submit this online form and the town will contact you.   Please note, if we cannot reach you for follow-up the appeal request will be closed and the parking ticket fine will double 15 days from the date printed on the front of the citation. 

 

If you wish to pay the parking citation now, please go to: www.leesburgva.gov/paybills.

Please provide all of the information requested below: 

 *

Please provide all of the information requested below:

Last Name

Middle Name

First Name

Email Address

Phone Numberext.

Mailing Address (Cannot be a PO Box)

 *

Mailing Address (Cannot be a PO Box)

Street Number

Street Name

City

State(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Vehicle Information

 *

Vehicle Information

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Plate Number

State That Issued Vehicle License Plate(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Ticket information

 *

Ticket information

Date of Citation

Ticket Number

Officer Name

Reason for Appeal

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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