Citation Appeal Form

If you are appealing a Black Butte Ranch Violation please complete the form below. If you are not going to appear in person for the appeal, please submit any documents or other evidence you would like to submit to the Review Panel at this time.

Note: This form is only for Black Butte Ranch Violations, not for a Oregon Uniform Citation. If you are unclear about what citiation you have been issued, call the Black Butte Ranch Police Department at 541-595-2191

Citation Number (required)

Alleged Violation (required)

Name of Person Appealing Citation (required)

Contact Phone Number (required)

Contact Email (required)

Are you a Black Butte Ranch homeowner? (required)

How would you like to appeal? (required)

Please write a statement explaining the basis for your appeal and/or and submit your documentation along with any other additional evidence below.

Documentation Submission. Attach any photographs, or other evidence that you would like to submit in support of your appeal.

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