PUEBLO COMMUNITY COLLEGE
OFFICE OF PUBLIC SAFETY
STUDENT CENTER & AUXILIARY SERVICES
********TICKET MUST BE ATTACHED********
Appeals must be received to the Office of Public Safety
within seven (7) days of date of occurrence
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Name S#
Ticket # Date of Ticket Date of Appeal
Home (or local) Address
City State Zip Code Telephone #
Vehicle Make License State Decal #
Smoking Violation
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Provide full and accurate explanation detailing basis for appeal. (Attach additional pages if needed.)
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"I affirm that the foregoing representations are true".
Signature Date
** OFFICE USE ONLY **
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Officer Notes:
Verdict Notice Sent
Decision Notes:
Office of Public Safety, Student Center, Room 160, Pueblo, CO 81004-1430