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.

QuestionAnswer
Form NameVs 35 Form
Form Length2 pages
Fillable?Yes
Fillable fields74
Avg. time to fill out15 min 22 sec
Other namesvs35 file online, vs 35 form, dmv vs35, dmv form vs 35

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

 

 

 

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