NOTICE OF APPEAL
(for a Denial or Revocation of a Driver/Vehicle Permit or Company Certificate)
PASSENGER VEHICLES FOR HIRE UNIT
Charlotte-Mecklenburg Police Department
4150 Wilkinson Blvd
Charlotte, NC 28208
Pursuant to Charlotte City Code, Chapter 22, Sec. 22-151, Appeal of manager’s decision, this form must be filled out
completely and filed with the PVH office within ten (10) working days of the decision being appealed. Attach additional sheets
as necessary. Mail or deliver to address shown above.
Name:
Date:
Street Address:
City:
State:
Driver’s License:
Date of Birth:
Zip:
Company Affiliation:
Select One:
 BOARD HEARING
PVH Denial/Suspension/Revocation Letter Date:
(Section 22-151 (c) requires a statement as to why the decision is improper. Appeals may be taken
only from the passenger vehicle for hire manger’s findings of fact and application of law.) State reasons
for appeal:
Witness Contact Information (or other persons to be at hearing)
Name:
Address:
City, State, Zip:
Appellant Signature:
Date:
Rev. 04/2016