Town of Severance Online Ticket Form

Town of Severance
3 South Timber Ridge Pkwy | PO Box 339
Severance, CO 80546
Phone: (970) 686-1218
Fax: (970) 686-6250

Online Ticket Form

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Notes: Penalty Assessment citations that are paid and postmarked within 20 days of the violation will result in an automatic point reduction. For each violation having a point value of three (3) or more points, two (2) points will automatically be reduced. For each violation having a point value of two (2) points, one (1) point will automatically be reduced. By paying the penalty assessment you acknowledge guilt of the charge and waive the rights listed on the back of your ticket. there is a 3% service fee for card payments The ticket number is in the top right corner consisting of 4-6 digits.*

Registration Information
First Name:	*
Last Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone:	*
Email:	*
Ticket Reference Number (4-6 Digit - See Above):	*
Date Citation was Issued:	*
Amount:	*	$

Terms and Conditions

In Consideration of Town of Severance granting permission to the undersigned the right to participate in the above activity, I hereby waive all claims for damage or loss to my person and property which may be caused by any act, or failure to act, of Town of Severance, its officers, agents, volunteers, or employees in connection with the above-named activity. I assume the risk of all dangerous conditions that may be involved in participating in the above-named activity and waive any and all specific notice of the existence of any such condition.

I, for myself and for my heirs, legal representatives, and assigns, in consideration of allowing me to participate in the above-named activity, covenant with Town of Severance its heirs, officers, agents, volunteers, or employees, to never institute any suit or action at law or in equity against Town of Severance its officers, agents, volunteers, or employees, by reason of any claim I may have that arises out of my participation in the above-named activity.

I, for myself and for my heirs, legal representatives, and assigns, do hereby release, acquit, and forever discharge Town of Severance, its officers, agents, volunteers, or employees and each of them for and from any and all claims, cause of action, suits, damages, injuries, and liabilities of every kind and nature, known or unknown, arising out of my participation in the above-named activity.

I agree to the Terms and Conditions