Pennsylvania Code › Title 16 - COMMUNITY AFFAIRS › Part II - Governor's Office › Subpart A - Human Relations Commission › Chapter 45 - HOUSING ACCOMMODATIONS/COMMERCIAL PROPERTY › Subchapter C - CITATION PROCEDURE-STATEMENT OF POLICY › Section 45.208 - Form

Current through Register Vol. 54, No. 28, July 13, 2024
COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA HUMAN RELATIONS
						COMMISSION
101 SOUTH SECOND STREET, SUITE 300 HARRISBURG, PA
						17105
CITATION
RESPONDENT FIRST NAME
MIDDLE
								  NAME
LAST NAME
1.
RESIDENCE
								  ADDRESS
CITY-TWP-BORO-COUNTY
STATE ZIP CODE
2.
BUSINESS ADDRESS
3.
CHARGE
4.
DATES(S) OF PUBLICATION
MANNER OF
								  PUBLICATION
COPY ATTACHED
5.
6.
YES __ NO __
STATUTE OR REGULATIONS
CIVIL PENALTY
TOTAL DUE $
7.
8. $
9.
I VERIFY THAT THE FACTS SET FORTH IN
								  THIS CITATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE OR INFORMATION
								  AND BELIEF. THIS VERIFICATION IS MADE SUBJECT TO THE PENALTIES OF SECTION 4804
								  OF THE CRIMES CODE (18 PA.C.S §
																4904)
								  RELATING TOO UNSWORN FALSIFICATION TO AUTHORITIES.
SIGNATURE
10.
DATE
								  ___________________________
REMARKS
11.
12. CITATION NO.
READ THE ATTACHED PLEA AND THE EXPLANATION OF YOUR RIGHTS
						AND OBLIGATIONS FOR SETTLEMENT OF THIS MATTER. YOU MUST ELECT AN OPTION AND
						FOLLOW THE APPROPRIATE DIRECTIONS WITHIN FIFTEEN (15) DAYS TO AVOID FURTHER
						LEGAL ACTION AGAINST YOU.
SHOULD YOU ELECT TO DEMAND A HEARING ON THIS MATTER,
						FOLLOW THE INSTRUCTIONS ON THE ATTACHED PLEA. YOUR HEARING DATE WILL BE SET BY
						A HEARING OFFICER. ALL HEARINGS ARE HELD IN HARRISBURG IN THE PENNSYLVANIA
						HUMAN RELATIONS COMMISSION CONFERENCE ROOM.
NOTICE OF RIGHTS AND OBLIGATIONS
1.
The original of this
								  citation will be filed with the Housing Director of the Pennsylvania Human
								  Relations Commission at Pennsylvania Human Relations Commission, Housing
								  Division, 101 South Second Street-Suite 300, Harrisburg, PA 17105.
2.
Within fifteen (15) days
								  of the issuance or receipt of this citation, you must:
a. ADMIT TO THE VIOLATION(S)
								  by signing the appropriate plea below and mailing the entire Citation along
								  with an amount equal to the Total Due as specified on the Citation (attached)
								  to the Housing Director, at the address listed above, or;
b.
DENY THE
								  VIOLATION(S)
i.
in whole by signing
								  the appropriate plea as specified in Section (b) of the Plea (attached) and
								  mailing the Citation along with an amount equal to the Total Due as specified
								  on the Citation (attached) to the Housing Director at the address listed
								  specified above.
ii.
in part by signing
								  the appropriate plea as specified in Section "c" of the Plea (attached) below
								  and mailing the Citation along with an amount equal to the Total Due as
								  specified on the Citation (attached) to the Housing Director at the address
								  specified above.
If you deny the violation(s), a
								  formal hearing will be scheduled in Harrisburg at which you may present
								  evidence on your behalf. Failure to appear at the formal hearing will result in
								  the entry of a default judgment against you for the full amount of the civil
								  penalty ("Total Due") as specified on the Citation.
3.
All payments must be made
								  by certified or cashier's check or money order and made payable to the
								  "Commonwealth of Pennsylvania," and mailed to the Housing Director at the
								  address specified above. Please place the Citation Number on certified or
								  cashier's check or money order. Personal Checks WILL NOT be accepted.
4.
FAILURE TO RESPOND WITHIN
								  THE TIME SPECIFIED ABOVE will result in the entry of a default judgment against
								  you for the full amount of the civil penalty ("Total Due") as specified on the
								  Citation. Failure to pay a civil penalty could result in additional fines and
								  the revocation, suspension or other disciplinary action against any license
								  which you may hold.
_______________________________________________________________________________________________
a.
I ADMIT to the
								  violation(s) on the reverse side of this Citation Signature Date
b.
I DENY the
								  violation(s) on the reverse side of this Citation Signature Date
c.
I ADMIT to
								  violations Enter Violation Number(s) here have enclosed the amount for these
								  violations and DENY the remaining violation(s) on the reverse side of this
								  Citation Signature Date
PLEASE PLACE THE CITATION NUMBER(S)
								  ON YOUR CERTIFIED OR CASHIER'S CHECK OR MONEY ORDER
_______________________________________________________________________________________________
A copy of the Pennsylvania Human Relations Commission's
						  guidelines and policy statement on advertising pursuant to Act 34 is attached
						  and incorporated by reference here unto.