INTERNATIONAL REGISTRATION PLAN AUDIT APPEAL FORM
FOR OFFICE USE ONLY
$10 Appeal Fee received:
£
YES
£
NO
USPM:
If you wish to appeal the findings of an International Registration Plan audit, MAIL THIS COMPLETED APPEAL FORM AND A $10
NON-REFUNDABLE APPEAL FEE TO THE NYS DMV APPEALS BOARD WITHIN 30 DAYS OF THE DATE OF THE LETTER SENT
WITH THE AUDIT FINDINGS.
The $10 APPEAL FEE must be paid by check or money order, payable to the “Commissioner of Motor
Vehicles.” DO NOT SEND CASH. Print the Audit number on your check or money order. Mail the APPEAL FORM and $10
APPEAL FEE to:
NYS DMV APPEALS BOARD
PO BOX 2935
ALBANY, NY 12220-0935
CERTIFICATION:
I affirm under penalty of perjury that all of the information submitted in
connection with this appeal is true.
Print Name:
SIGN HERE:
TYPE or PRINT all information clearly
Last Name
First Name
M.I.
Business or Corporate Name
IRP Account No.
Mailing Address (Number and Street)*
City or Town
State
Zip Code
AA-AUD1 (10/16)
PAGE 1 OF 2
Audit No. Assessment Amount:
Attorney name and address, if applicable:
*All correspondence for this appeal will be sent to the address you provide on this appeal form. You must notify the Appeals Board immediately in writing
of any change of address that occurs after the appeal has been filed.
In the space below, state the reasons for filing this appeal. Do not leave this section blank. Attach additional pages if necessary.
Read and sign the certification at the bottom of this page.
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