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