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Vs 35 Form PDF 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.

Question	Answer
Form Name	Vs 35 Form
Form Length	2 pages
Fillable?	Yes
Fillable fields	74
Avg. time to fill out	15 min 22 sec
Other names	vs35 file online, vs 35 form, dmv vs35, dmv form vs 35

12

Form Preview Example

COMPLAINT REPORT

Division of Vehicle Safety

INSTRUCTIONS: (Before you file your complaint, please try to settle this matter with the facility.)

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

o Vehicle repair

o Vehicle inspection

o Vehicle purchase

We can only accept complaints about repairs up to 90 days or 3,000 miles (whichever comes first) after the date repairs were completed. The only exception is a written warranty that may exceed these time and/or mileage limits.

PLEASE PRINT OR TYPE ALL ENTRIES AND USE BLACK INK

FOR OFFICE USE ONLY

Facility

Number

C.O. Case

Number

CSR

Region	County

R.O. Case

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) (			)

Your Email Address							Identification Number
							of Facility

Vehicle Identification							Name of person with whom
Number							you dealt at facility

Vehicle Year, Make, Model				Plate		Cylinders	Today’s			Current odometer reading at time
				Number			Date	/	/	of filing the complaint

Date of repair/inspection/purchase			Odometer reading at time of repair/
/	/		inspection/purchase
/	/

ANSWER QUESTIONS BELOW AND/OR ON PAGE 2 OF THIS FORM THAT APPLY TO YOUR COMPLAINT

A. Repair Complaint

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? o Yes								o No If Yes, attach a copy of the estimate.
3.	What was the actual cost of repair? $				(Attach invoice)
4.	Before the repair was performed, did you ask that any replaced part be returned to you? o Yes								o No
	If Yes, do you have the replaced parts? o Yes o No
5.	Did you authorize any additional repairs? o Yes			o No Specify
6.	Were you charged for work not performed? o Yes			o No Explain

	____________________________________________________________________________________________________________
7.	Was any unnecessary or unauthorized work performed? o Yes o No Specify

8. Did you go to another facility to have the problem corrected? o Yes*							o 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. (		)

VS-35 (8/19)

PAGE 1 OF 2

Your

B. Inspection Complaint

Name

Vehicle Identification

o Yes o No

1.

Did the inspection station refuse to inspect your vehicle?

Number

2.

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

o No

3.

Were you told or led to believe that repairs necessary to pass inspection had to be made at the same station? o Yes o No

4.

How much were you charged for the inspection? $

5.

Inspection Certificate #

Expiration Date

/

/

6.

Did you receive an inspection receipt? o Yes o No

If Yes, attach a copy of the receipt.

C. Vehicle Purchase Complaint

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

1.

Were any vehicle components in need of repair or adjustment?

o Yes o No If Yes, which components?

2.

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

oNo

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

repairs or adjustments? o Yes o No

3.

Was a Temporary Certificate of Registration issued? o Yes

o 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 A on 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? o Yes o No

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. Email is the preferred and most efficient method of communication.

Sign below and email or mail this complaint form with all necessary attachments to: CSR@dmv.ny.gov or BUREAU OF CONSUMER &

FACILITY SERVICES, PO BOX 2700-ESP, ALBANY NY 12220-0700. 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. By written or typed signature, I attest that all information provided in this complaint is true and factual to the best of my knowledge.

X

(Written or Typed Signature)

(Date)

VS-35 (8/19)	dmv.ny.gov	reset/clear	PAGE 2 OF 2
		reset/clear

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