Violation Appeal Form – Fill Out and Use

(WEB COPY)

Toll Violation Appeal Form for Massachusetts Registration Only

E-ZPass MA Violation Processing Center (VPC)

PO Box 8001, Auburn, Massachusetts 01501-8001

The Massachusetts Registry of Motor Vehicles has identified you as the registered owner of the vehicle and responsible party for the attached Toll Violation Notice. You may appeal this violation under the provisions of Massachusetts Code of Regulations 730 CMR 7.04. You must appeal the violation in writing, by submitting this form to the Violation Processing Center (VPC) by the Due Date shown below. Late appeals will not be accepted. This Toll Violation

Appeal applies only to the violation number you indicated below. (Required Fields*)

*Name:				*Violation Number:
*Address:				*Issuance Date:
*City, State, Zip:				*Registration No.:_______________________________
Please check one to indicate requested appeal method:

Written Appeal: Fill out information below and mail this form to the VPC

Request for Hearing (in Auburn, Massachusetts): Mail this form to the VPC

______ Check here ONLY if this is your FIRST E-ZPASS MA VIOLATION OFFENSE

IMPORTANT NOTE: TELEPHONE AND EMAIL APPEALS CANNOT BE ACCEPTED.

Submission of this written appeal does not waive your right to a hearing with a MassDOT Examiner or subsequent judicial review under Massachusetts law (M.G.L. c. 30A). Within sixty (60) days of receipt of your appeal you will receive a disposition report from the VPC either dismissing or upholding the violation. For your convenience, a list of possible valid appeal circumstances is provided below.

1.) CHECK HERE _____IF YOUR E-ZPASS ACCOUNT WAS OPENED IN THE STATE OF MASSACHUSETTS

If you have not already contacted an E-ZPass MA customer service representative to resolve the problem that led to your violation, please call [1-877-627-7745] (select option 3) in order to avoid future violations and fines. Please note that this phone call is to update your account information and will not relieve you of your obligation to appeal this violation in writing.

You are then encouraged to appeal this violation by filling out the information below and mailing this Appeal Form to the VPC. If your appeal is received by the due date shown above and accepted, you acknowledge (by signing below) that the $50.00 violation fine will be waived, and that the missed toll amount and a $5.00 violation administrative fee will be charged to your E-ZPass account.

E-ZPass MA Account Number: ____________________________

E-ZPass MA Transponder Number : *021____________________________________________

2.) CHECK HERE _____IF YOUR E-ZPASS ACCOUNT WAS NOT OPENED IN THE STATE OF MASSACHUSETTS

If you have not already contacted an E-ZPass customer service representative to resolve the problem that led to your violation, please refer to the agency and phone number listed on your transponder. You are then encouraged to appeal this violation by filling out the information below and mailing this Appeal Form to the VPC with a copy of your current E-ZPass statement, which must include your name, address, transponder number, and vehicle registration information. If your appeal is received by the due date shown above and accepted, you acknowledge (by signing below) that the $50.00 violation fine will be waived, and that the missed toll amount and a $5.00 violation administrative fee will be charged to your E-ZPass account. In order to avoid future violations and fines, please contact E-ZPass Customer Service where you opened your account to resolve the problem that led to the violation. Please note that contacting Customer Service will not relieve you of your obligation to appeal this violation in writing.

IMPORTANT NOTE TO E-ZPASS ACCOUNT HOLDERS OUTSIDE OF MASSACHUSETTS - WE WILL BE UNABLE TO PROCESS YOUR APPEALS WITHOUT COMPLETE DOCUMENTATION OF AN E-ZPASS ACCOUNT AS DESCRIBED ABOVE.

Please sign below. Your signature is required for appeal to be considered. Appeals received after the due date will not be processed.

_________________________	_________________________	_______________________ __________________
*Signature	*Print Name	*Phone Number	*Date

(WEB COPY)

Toll Violation Appeal Form for Massachusetts Registration Only

E-ZPass Massachusetts Violation Processing Center (VPC)

PO Box 8001, Auburn, Massachusetts 01501-8001

The Massachusetts Registry of Motor Vehicles has identified you as the registered owner of the vehicle and responsible party for the attached Toll Violation Notice. You may appeal this violation under the provisions of Massachusetts Code of Regulations 730 CMR 7.04. You must appeal the violation in writing, by submitting this form to the Violation Processing Center (VPC) by the Due Date shown below. Late appeals will not be accepted. This Toll Violation

Appeal applies only to the violation number you indicated below only. (Required Fields*)

*Name:				*Violation Number:
*Address:				*Issuance Date:
*City, State, Zip:				*Registration: ____________________________________

Check here ONLY if this is your FIRST E-ZPASS MA VIOLATION OFFENSE

_____ Check here for Other Circumstances (Non-E-ZPass Customer) (Complete next section)

If you elect to contest your liability on the basis of Other Circumstances, please prepare a written statement (using the space provided below) explaining why your vehicle was utilizing an E-ZPass MA lane in violation of the Massachusetts Department of Transportation’s regulations.

Ifyou need additional space, or are including additional documentation with your appeal, please include your license plate number and violation number (shown above) on all documents and/or other submittals. Please sign below. Your signature is required for an appeal to be considered. Appeals received after the due date will not be processed.

_________________________	_________________________	______________________ _________________
*Signature	*Print Name	*Phone Number	*Date

Area below for Leasing and Rental Agencies ONLY

The Undersigned registered owner certifies that, on the date of the violation, the vehicle bearing the license plate number on the violation notice was a: Leased or Rented Vehicle. For this appeal to be considered, all lessee/renter information is required by M.G.L. Chapter 90, Section 20E and must be provided within forty-five (45) days of date of issuance.

IMPORTANT: The leasing/rental company must provide this information for the appeal to be accepted. The violation notice may NOT be forwarded to the lessee/renter for payment or appeal.

*NAME:

*ADDRESS:

*CITY:		*STATE:		*ZIP CODE:

Please sign below. Your signature is required for an appeal to be considered. Appeals received after the due date will not be processed.

_________________________	_________________________	________________________ _________________
*Signature	*Print Name	*Phone Number	*Date