Form Aa 33 New York – Fill Out and Use

WHAT IS REQUIRED TO FILE AN APPEAL: You must send this COMPLETED, SIGNED APPEAL FORM (2 pages) and a $10 APPEAL FEE to the DMVAppeals Board. Read this entire form carefully.Type or print your information clearly.You must state your appeal reasons on page 2 of this form.You must pay a $10 appeal fee for each TVB ticket you appeal. DO NOT SEND CASH. Make your check or money order payable to the “Commissioner of MotorVehicles.” Print your ticket number on your check or money order.Appeal fees are non-refundable.A$35 penalty is charged for dishonored checks.

DEADLINE TO FILEANAPPEAL: You must send the APPEAL FORM andAPPEAL FEE to the DMV Appeals Board within THIRTY (30) DAYS of the conviction or hearing date. If you file by mail, the USPS postmark will be used to determine if your appeal is timely. If the postmark is illegible, the date your appeal is received will be used to determine timeliness.You should keep copies of your completed appeal form, appeal fee,and proof of mailing.

WHERE TO SEND YOURAPPEAL: Mail the appeal form and appeal fee to: DMV Appeals Board

Appeals Processing Unit

P.O. Box 2935

Albany, NY 12220-0935

To file an APPEAL ONLINE,go to the DMV website at:www.dmv.ny.gov.

The Appeals Board will send you a letter acknowledging receipt of your appeal. If you do not receive such letter within 20 days after filing your appeal, contact theAppeals Board at (518) 474-1052 or at the above address.

ISSUES RAISED ONAPPEAL: TheAppeals Board may review both the guilty determination and penalty if a transcript is timely submitted. If the only issue raised on appeal is the penalty, theAppeals Board will not need to review a hearing transcript.

Check the appropriate box.

I APPEAL THE GUILTY DETERMINATION AND PENALTY. I UNDERSTAND THAT I AM REQUIRED TO PAY THE TRANSCRIPTION COMPANY FOR THE HEARING TRANSCRIPT TO BE SUBMITTED TO THEAPPEALS BOARD FOR REVIEW.

The Appeals Board will acknowledge receipt of your appeal form and fee with a letter that will direct you to pay a $50 transcript deposit to the Transcription company within 30 days of the letter. TheAppeals Board does not accept transcript payments. By law, if you do not pay theTranscriber in a timely manner, theAppeals Board cannot reviewthe guilty determination and may review the penalty only.

I APPEAL THE APPROPRIATENESS OF THE PENALTY ONLY (fine, suspension/revocation) AND ACCEPT THE GUILTY VERDICT. I UNDERSTAND THAT THEAPPEALS BOARD WILL NOT REVIEW THE TRANSCRIPT ORANY STATEMENTS MADEAT THE HEARING.

I DID NOT APPEAR BEFORE A HEARING OFFICER and/or NO TRAFFIC VIOLATIONS BUREAU HEARING WAS HELD. THE APPEAL WILL BE REVIEWED WITHOUTATRANSCRIPT.

STAY OF SUSPENSION OR REVOCATION PENDING APPEAL: The Appeals Board will not grant a stay unless you provide (on page 2) valid

reasons for requesting the stay and for submitting the appeal.You will be notified of the decision to grant or deny your stayrequest.

I REQUEST THAT THE SUSPENSION OR REVOCATION OF A LICENSE, PERMIT OR PRIVILEGE RESULTING FROM THE TVB CONVICTION BE STAYED OR STOPPED PENDING THE OUTCOME OF THEAPPEAL.

FINE PAYMENTS: EVEN IF YOU FILEANAPPEAL, YOU MUST PAY THE FINEAND SURCHARGES RESULTING FROM THE CONVICTION. UNPAID FINES, SURCHARGES, OR TERMINATION FEES WILL RESULT IN LICENSE SUSPENSIONS, WHICHARE NOT STAYED BY THE BOARD. Do not send fine payments to theAppeals Board. Send payments forTVB fines and surcharges to: DMV Traffic Violation Division Plea Unit

P.O. Box 2950-ESP

Albany, NY 12220-0950

REQUIRED APPEAL INFORMATION: All correspondence for this appeal will be sent to the address(es) supplied on this appeal form.You must notify theAppeals Board in writing immediately of any change of address that occurs after this appeal is filed.

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NewYork State Department of MotorVehicles

TRAFFIC VIOLATIONS BUREAU (TVB)APPEAL FORM

WHAT RECORDSARE REVIEWED: Any exhibits submitted at the hearing will become part of the appeal record.TheAppeals Board reviews the entire record created at the hearing level, but evidence, exhibits or documents not submitted to the hearing officer may not be filedwith or reviewed by theAppeals Board.

To receive copies of hearing exhibits for your personal use, you must submit a FREEDOM OF INFORMATION LAW (FOIL) request to the DMV FOIL Office at: 6 Empire State Plaza,Albany, NY 12228. Information for obtaining DMV records and FOIL forms areavailable online atwww.dmv.ny.gov.

APPEALARGUMENTS: INTHE SPACE BELOW,YOU MUSTSTATETHE REASONSWHYYOUARE FILINGTHISAPPEAL.TYPE OR PRINT CLEARLY.Attach additional pages, if necessary. By law, personal appearances and oral arguments are not permitted on appeal. If you request a stay, you must state the reasons for the request. If you order a transcript, you will have 30 days to submit additional arguments from the date the transcript is sent to you.After the 30-day period, your appeal will be reviewed and decided.

SIGN AND DATE YOUR APPEAL: I affirm under penalty of perjury that all of the information on this form and all supporting documents submitted with this appeal are true, and that no prior appeal has been made in this matter.

HAVE YOU:

You will receive written notification of the outcome of the appeal. If theAppeals Board dismissesthe conviction, the fine will be refunded.