Note to Mac users & Google Chrome users:this web form is not submittable with Apple computers/software nor Google Chrome browser. We will accept a screen print in a Word document or as a JPG or PDF. Feel free to print and fax us the form.
Note: We ask that you provide evidence corresponding with your citation that will support your circumstance, such as a proof of registration, a handicapped placard, etc. You may send a scanned copy of this information in a separate e-mail to firstname.lastname@example.org with your citation number as the subject title, send it in the mail, or fax it to 402/441-6476