Forms • Libertyville • CivicEngage

Request for Administrative Adjudication Hearing - Non Appearance Submission & Waiver

Leave This Blank:

VEHICLE, ORDINANCE, & BUILDING CODE RELATED VIOLATIONS

Any person who has been served a violation notice for a qualifying vehicle, ordinance, or building code related violation and who is not a resident of the Village of Libertyville may contest the alleged violation on its merits without personally appearing before a Hearing Officer.

This form must be completed in its entirety, including a certified statement of facts specifying the grounds for challenging the violation notice.

It cannot be used for red light violations, traffic or criminal citations.

Do NOT complete and submit this form if you wish to contest a parking, ordinance, or building code violation in person. Go back to the Administrative Adjudication page and click on the link for Administrative Adjudication Hearing Request

Name*

Address*

City*

State*

ZIP*

Phone Number*

Email*

Citation Type*

	Parking
	Building Code

Ordinance (Curfew, Tobacco, etc.)

Citation date*

Citation Number*

Violation Description*

I choose to contest this citation by mail. I am waiving my personal appearance before a Hearing Officer. I agree to adjudication by the Hearing Officer based upon the below certified statement.*

I understand and agree

I do not understand and do not agree

Please provide your written statement:*

In lieu of a signature, type your full name in to affirm that you understand and agree to the following:

Under penalties of perjury as provided by law pursuant to 735 ILCS 5/10-109 of the Code of Civil Procedures, the undersigned certifies the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as such matters the undersigned certifies as aforesaid that I believe the same to be true.*

Upon submitting this form, the Libertyville Police Department will schedule you for the next available hearing date. You will be mailed a hearing notice within 3 business days of your submission. If you do not receive a hearing notice or need additional information, please contact us at (847) 918-2038

* indicates required fields.

Live Edit

Village of Libertyville

Site Links