SM Appeal form Revision FINAL 03272017For Office Use Only
APPEAL CASE: SMA #
Office of the Special Master
1700 Convention Center Drive, 1st Floor
Miami Beach, Florida 33139 Date/Time Appeal Received:
Telephone: 305.673.7181
NOTICE OF APPEAL TO SPECIAL MASTER
INSTRUCTIONS:
An appeal of a Notice of Violation must be timely filed. Failure to seek an appeal within the proscribed appeal time,
will constitute a waiver of the violator’s right to the administrative hearing, and shall be deemed an admission of the
violation.
The appeal must include your name, mailing address, daytime telephone number and a copy of the Notice of Violation
(front and back).
Simultaneously with your written appeal, you must submit a $100 appeal fee. Checks must be made payable to the
City of Miami Beach. If you prevail in your appeal, your appeal fee will be refunded.
If you wish to utilize this Notice of Appeal form, answer all questions as completely as possible.
You may attach an explanatory letter and/or documents that you think will help the Special Master evaluate your
appeal.
Return your written appeal and/or this Notice of Appeal form to the Office of the Special Master, 1700 Convention
Center Drive, 1st Floor, Miami Beach, FL 33139.
Keep copies of all documents you submit to the Clerk of the Special Master for your records.
NOTICE OF VIOLATION NUMBER:
APPELLANT/VIOLATOR:
NAME:
MAILING ADDRESS:
TELEPHONE: ( ) E-MAIL:
ADDRESS OF VIOLATION:
I, the Appellant named above, wish to appeal the above-referenced Notice of Violation.
Appellant’s Signature Date
Appellant’s Printed Name
Additional Information To Be Provided If Represented By An Attorney:
ATTORNEY NAME: FLORIDA BAR NUMBER:
ADDRESS:
TELEPHONE: ( ) E-MAIL:
Attorney’s Signature Date
Notice to Appellant/Attorney: The Special Master Clerk will send a Notice of Hearing to the mailing address
of the Appellant or, if represented by an attorney, to the attorney indicated on this form.
CLERK OF THE SPECIAL MASTER USE ONLY
Payment Method: □ Check □ Cash □ Credit Card Copy of Violation Attached (front and back) □ Yes □ No
Timely Appealed: □ Yes □ No MCR No.:
Processed by: Date:
F:\CLER\$ALL\SPECIAL MASTER\SM APPEAL FORM\SM Appeal form Revision FINAL 03272017.docx