Fillable PARKING/CAMERA VIOLATIONS APPEAL APPLICATION Instructions: Use this form (City of New York)

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PARKING/CAMERA VIOLATIONS APPEAL APPLICATION Instructions: Use this form (City of New York)

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NEW YORK CITY DEPARTMENT OF FINANCE
l
ADJUDICATION DIVISION
PARKING/CAMERA VIOLATIONS APPEAL APPLICATION
Instructions: Use this form only if you want to request an appeal of your hearing deci-
sion. If you accept the Judge’s decision and are going to pay or have paid the amount
imposed, you should not submit this form.
Daytime
1. Name:___________________________________________________________ Phone Number: ________________________
FIRST LAST
2. Address: ________________________________________________________________________________________________
NUMBER AND STREET APT.NO. CITY STATE ZIP CODE
3. I am: (check one) q the registrant q the operator q a representative of the registrant or operator
SECTION A. RESPONDENT INFORMATION (Please Print)
Print clearly and use additional sheets if needed.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
SECTION C. REASONS WHY YOU BELIEVE THE JUDGE’S DECISION SHOULD BE REVIEWED
______________________________________________________________________________ Date: ___________
/
___________
/
___________
SECTION D. APPELLANT’S OR REGISTRANT’S SIGNATURE
1. Vehicle State of Vehicle
plate #: ___________________________ Registration: _________ Make: ________________________________________
2. WHAT WAS THE
ORIGINAL HEARING DATE:
________
/
________
/
________
3. AMOUNT PAID: $ __________________________________________
4. NUMBER OF VIOLATIONS BEING APPEALED: ____________
Fill in each violation number below. If you are appealing more than 8 violations, attach a separate appeal application listing the
additional ones.
SECTION B. VEHICLE & VIOLATION INFORMATION
PVO-0100-online Rev. 04.16.2019
-
Visit Finance at nyc.gov/finance
1 5
2 6
3 7
4 8
If your ticket(s) is already in judgment, while you are waiting for your appeal
decision, interest may be added and towing and other enforcement actions
may be taken. You can avoid this by paying your outstanding parking debt.
1. Only the registered owner, the driver or an authorized representative of either (such as an attorney)
may request an appeal. (See Section A.)
2. You must request your appeal within 30 calendar days of the hearing decision.
3. If you wish to appeal in person, we will schedule it and notify you of the date and time.
q I want to appear in person.
4. With your application, send the following (one set for each license plate):
a. the original Judge's decision;
b. a copy or copies of the original ticket(s) and/or Notices of Liability, and
c. copies of all evidence submitted at the original hearing.
5. The Appeals Panel will only review correct and complete applications. Incomplete, unsigned appli-
cations or those without the required documents will be returned to the applicant.
6. Once your Appeal is heard, we will send the decision to the address in Section A within 30 days of
the decision date. If your appeal is successful, we will also refund any payment.
7. q I require a sign language interpreter.
APPLICATION INSTRUCTIONS
u By Internet, using credit or debit card: go to nyc.gov/finance.
u At a Finance Business Center, you may pay by credit or debit card, check, money order or
cash. For locations, call 311 or go to nyc.gov/finance
u By Mail: Make your check or money order out to the "New York City Department of Finance.”
Do not mail cash. Write the 10-digit Parking Ticket/Camera Violation Notice of Liability num-
ber(s), the license plate number(s) and the state in which the vehicle is registered on the front
of your payment.
PAYMENT INSTRUCTIONS
Send your completed form and the required documents if:
MAILING INSTRUCTIONS
PAYMENT IS INCLUDED WITH APPLICATION TO:
NYC DEPARTMENT OF FINANCE
ADJUDICATION DIVISION
PO BOX 3615, CHURCH STREET STATION
NEW YORK, NY 10008-3615
PAYMENT IS NOT INCLUDED WITH APPLICATION TO:
NYC DEPARTMENT OF FINANCE
ADJUDICATION DIVISION - APPEALS UNIT
66 JOHN STREET, 3RD FLOOR
NEW YORK, NY 10038
Please keep a copy of your completed application and everything you submit for your records.
If you have questions, call 311 (24 hours / 7 days a week).
If
calling from outside of the five NYC boroughs, please call 212-NEW-YORK (212-639-9675).
For TTY service for the hearing impaired, call 212-504-4115.
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PARKINGCAMERA VIOLATIONS APPEAL APPLICATION Instructions: Use this form (City of New York)

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Completed 12 October 2020

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