Form Pv 0101 – Fill Out and Use This PDF

	NEW YORK CITY DEPARTMENT OF FINANCE l PROGRAM OPERATIONS DIVISION l REFUNDS UNIT
	PARKING / CAMERA VIOLATIONS REFUND FORM
FINANCE	Mail to: NYC Department of Finance - Refunds Unit, 59 Maiden Lane, 20th Fl., New York, NY 10038

Please see instructions for further details and complete all sections below. Keep a copy for your records.

Plate Number:

State:

Violation #:

SECTION A: CONTACT/REGISTRANT INFORMATION

Please Print or Type:

Daytime

1. Name: __________________________________________________________ Phone Number: ________________________

FIRSTLAST

2. Address: _______________________________________________________________________________________________

NUMBER AND STREET	CITY	STATE	ZIP CODE
3. I am the (check one): q Registered Owner	q Not the Registered	4. Email:	____________________________
of the vehicle	Owner of the vehicle
SECTION B: PAYMENT INFORMATION
Paid By (Check One):
1. q Credit/Debit Card (Confirmation or Receipt #:____________________)		q Other: ___________________________

SECTION C: REFUND REQUEST INFORMATION

I am requesting a refund because:

1.q The amount paid was reduced by a hearing or an appeal hearing after payment. (A copy of your hearing or appeal board determination must be attached.)

2.q I paid the same violation more than once.

3.q The violation was not a parking or camera violation. (It was a traffic violation or a violation issued by another agency or jurisdiction.)

4. q Other (Please explain. Example: I paid more than the amount due; etc.)

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

SECTION D: BOOT OR TOW FEE REFUND INFORMATION

If you are requesting a boot or tow fee refund, a copy of the receipt or payment voucher must be attached. Please note that, in order to claim a refund, the related summons(es) must have been dismissed.

I am requesting a refund of boot or tow fees because:

1.q The vehicle was booted or towed in error.

2.q The violations were dismissed in a hearing after the vehicle was redeemed.

SECTION E: CERTIFICATION

I hereby affirm that I am entitled to a refund in the amount of $________________ for the reason(s)

claimed above. The attached documents, if any, submitted in support of my claim are unaltered.

________________________________________________	______________________________
Signature	Date
Visit Finance at nyc.gov/finance	PV-0101 Rev. 04.03.2014

Parking and/or Camera Violations Refund Form	Page 2

GENERAL INSTRUCTIONS

1.REGISTERED OWNER: Finance will issue a refund of parking and/or camera violation overpayments to the registered owner of the vehicle within 30 days. The registered owner does not need to file this form to claim a refund of these overpayments. A check will auto- matically be generated and mailed to the registrant’s address on file with the Department of Motor Vehicles.

2.OTHER THAN THE REGISTERED OWNER: If an individual other than the registered owner made payment, (s)he must complete this form to claim the refund. If payment was made at one of the Business Centers, you must attach a copy of the payment receipt.

3.BOOT OR TOW REFUNDS: You must complete this form to claim a refund. Refunds are not generated automatically. To avoid processing delays, be sure to include a copy of the receipt or payment voucher.

4.CREDIT/DEBIT PAYMENT: If you made the payment using a credit or debit card, you must include:

l A copy of the payment receipt or confirmation number, and l A daytime phone number.

This information is necessary to process your credit/debit refund request. Your refund will generally be credited to your credit/debit card account. However, checks are sent for boot or tow refunds.

5.Please provide all information requested on this form, including your vehicle plate and vio- lation numbers.

For Parking or Camera Violation Refund Inquiries,

Contact Finance at:

parkingrefund@finance.nyc.gov

Or

Call 311