Vs 35 Nys Dmv Details

Vs 35 form is a document that is used to report the outcome of an election. The form is created by the each state's board of elections and helps to ensure the accuracy of election results. The form can be used to report the results of a primary, general, or special election.

You can find more details in regards to the vs 35 form by checking out the table we compiled.

QuestionAnswer
Form NameVs 35 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdmv vs 35, dmv vs35 form, amazon, vs35 file online

Form Preview Example

VS-35 (3/11)

 

New York State Department of Motor Vehicles

 

 

 

 

 

FOR OFFICE USE ONLY

 

 

 

 

Division of Vehicle Safety

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility

 

 

 

 

 

COMPLAINT REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS: (Before filing your complaint, please attempt to settle this matter with the facility.)

 

C.O. Case

 

 

Check the appropriate box to show the type of complaint involved.

 

 

 

 

Number

 

 

 

 

 

 

CSR

 

 

Vehicle repair

Vehicle inspection

Vehicle purchase

 

 

 

 

 

 

 

 

 

 

 

We can only accept complaints about repairs up to 90 days or 3,000 miles (whichever

 

 

 

 

 

Region

 

County

comes first) after the date repairs were completed. The only exception is a written warranty that

 

 

 

 

may exceed these time and/or mileage limits.

 

 

 

 

 

 

 

 

R.O. Case

 

 

PLEASE PRINT OR TYPEALLENTRIESAND USE BLACK INK

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your

 

 

 

 

 

 

 

 

Name of

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

Facility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address - Number

 

 

 

 

 

 

 

Address - Number

 

 

 

 

 

and Street

 

 

 

 

 

 

 

 

and Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

Zip Code

City

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (Include area code)

 

 

 

 

Telephone Number

 

 

 

 

 

Home (

)

 

 

Work (

)

 

 

 

(Include area code) (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification

 

 

 

 

 

 

 

Identification Number

 

 

 

 

Number

 

 

 

 

 

 

 

 

of Facility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Year, Make, Model

 

 

Plate

 

 

Cylinders

Name of Person with whom

 

 

 

 

 

 

 

 

Number

 

 

 

 

you dealt at facility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of repair/inspection/purchase

Odometer reading at time of repair/

Today’s

 

 

Current odometer reading at time

/

/

 

inspection/purchase

 

 

 

Date

/

/

of filing the complaint

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWER QUESTIONS BELOWAND/OR ON PAGE 2 OF THIS FORM THATAPPLYTO YOUR COMPLAINT

A.RepairComplaint

1.Describe the specific reason you brought the vehicle to the repair shop:____________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

2.

Did you ask for a written estimate of the parts and labor necessary to do the repair? Yes

No

If Yes, attach a copy of the estimate.

3.

What was the actual cost of repair? $____________________ (Attach invoice)

 

 

 

 

 

4.

Beforetherepairwasperformed,didyouaskthatanyreplacedpartbereturnedtoyou?Yes

No

 

 

 

IfYes,doyouhavethereplacedparts?

Yes

No

 

 

 

 

 

 

 

 

5.

Did you authorize any additional repairs? Yes

No

Specify ______________________________________________________

6.

Were you charged for work not performed? Yes No Explain

____________________________________________________

 

____________________________________________________________________________________________________________

 

____________________________________________________________________________________________________________

7.

Was any unnecessary or unauthorized work performed? Yes

No Specify

__________________________________________

 

____________________________________________________________________________________________________________

 

____________________________________________________________________________________________________________

8.

Did you go to another facility to have the problem corrected? Yes*

No

 

 

 

 

 

 

* If Yes, attach invoice and give us the following information about the facility:

 

 

 

 

 

 

Name _____________________________________________________________ Facility ID No. ______________________________

 

Street________________________________________________________________________________________________________

 

City __________________________ State __________ Zip Code _____________ Telephone No. (

)

______________________

B.InspectionComplaint

 

 

 

 

 

 

 

 

 

 

1.

Did the inspection station refuse to inspect your vehicle? Yes

No

 

 

 

 

 

2.

Did the inspection station refuse to give you an appointment date in writing? Yes

 

No

 

 

3.

Were you told or led to believe that repairs necessary to pass inspection had to be made at the same station?

Yes No

4.

How much were you charged for the inspection $___________________.

 

 

 

 

 

5.

Inspection Certificate # _________________________

Expiration Date

/

/

 

 

 

6.

Did you receive an inspection receipt?

Yes

No

If yes, attach a copy of the receipt.

 

 

 

 

 

 

 

 

 

 

 

 

 

PAGE 1 OF 2

C.VehiclePurchaseComplaint

 

 

 

Attach a copy of your Bill of Sale and/or Certificate of Sale.

 

 

 

1.

Were any vehicle components in need of repair or adjustment?

Yes

No

If Yes, which components? ____________________

 

____________________________________________________________________________________________________________

2.

Have you gone back to the dealer for repairs or adjustments?

Yes

No

If No, would you go back if the dealer offered to make

 

repairs or adjustments? Yes No

 

 

 

3.

Was a Temporary Certificate of Registration issued? Yes

No

If yes, what is the facility number written on the temporary

 

registration? ___________________________

 

 

 

4. Inspection Certificate # _________________________ Expiration Date _________________________

/ /

NOTE: If a repair or diagnosis of the vehicle was made, complete Section Aon the front of this form.

D.If there is additional information that will help us to evaluate your complaint, please include this information below or use an additional sheet of paper..

E.What do you want done to resolve this complaint to your satisfaction?

Are you willing to appear and testify at a hearing if one is held to resolve this complaint? Yes No

Be sure to attach COPIES of any supporting correspondence and/or documents such as receipts, invoices, written estimates, written guarantees or warranties, cancelled checks or credit card transaction forms.

Sign below and mail this complaint form with all necessary attachments to: BUREAU OF CONSUMER & FACILITYSERVICES, PO BOX 2700-

ESP,ALBANYNY12220-0700. Phone #: (518) 474-8943 Fax:(518) 486-4102

I understand that a copy of this form and any or all of the enclosed information may be sent to the facility shown on the front of this form. All information provided in this complaint is true and factual.

 

________________________________________________

_______________________

(Signature)

(Date)

VS-35 (3/11)

www.dmv.ny.gov

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