Form AA-33A - Administrative Appeal Form - New York

YOU MUST COMPLETE PAGE 2 OF THIS FORM.
New York State Department of Motor Vehicles
ADMINISTRATIVE APPEAL FORM (AA-33A)
VEHICLE AND TRAFFIC LAW ARTICLES 3-A and 12-A
(THIS FORM IS NOT TO BE USED TO APPEAL TRAFFIC VIOLATION BUREAU TICKETS)
I REQUEST THAT THE FINE, SUSPENSION OR REVOCATION BE STAYED (STOPPED) PENDING THE OUTCOME OF THE APPEAL.
Stays pending appeals are granted in the discretion of the Board (except for most Article 12-A appeals). The Appeals Board will not grant a stay unless the
appeal fee is paid and valid reasons for the appeal and for needing the stay are provided on page 2 of this form. You will be notified whether your request
for a stay has been granted or denied.
If a hearing was held, the Appeals Board may review hearing testimony only if you order and pay for a transcript in a proper and timely manner. The Appeals
Board will acknowledge receipt of your appeal form and fee with a letter that will direct you to send a transcript deposit to the designated Transcription company
within 30 days of the date of the letter. The Appeals Board does not accept transcript payments
. If you do not receive an acknowledgment letter, contact the Appeals
Board at (518) 474-1052 or at the address above. The Appeals Board will not review hearing testimony unless all transcript payments are timely and complete.
IF A HEARING WAS HELD, check the appropriate box below:
You must send this COMPLETED, SIGNED APPEAL FORM (2 pages) and a $10 APPEAL FEE to the DMV Appeals Board. Read this entire form carefully.
Type or print all information clearly. You must state your reason for the appeal on page 2 of this form. You must pay a non-refundable
$10 appeal fee for
each CASE NUMBER you appeal
. DO NOT SEND CASH. Appeal fees must be paid by check or money order, payable to the “Commissioner of Motor
Vehicles.” Print your case number(s) on your check or money order. A $35 penalty is charged for dishonored checks.
You must send this
APPEAL FORM and the APPEAL FEE(S) to the DMV Appeals Board WITHIN SIXTY (60)
DAYS OF THE DATE OF THE DEPARTMENT’S ORDER OF SUSPENSION/REVOCATION, DECISION LETTER,
OR NOTICE
. If you file by mail, the USPS postmark will be used to determine if your appeal is timely. If the
postmark is illegible, the date your appeal is received by the Board will determine timeliness. You should keep
copies of your completed appeal form, appeal fee, and proof of mailing.
I WANT THE HEARING TESTIMONY REVIEWED BY THE BOARD. I UNDERSTAND THAT I AM REQUIRED TO PAY A TRANSCRIPT DEPOSIT TO THE
TRANSCRIPTION COMPANY WITHIN 30 DAYS OF THE DATE OF THE LETTER ACKNOWLEDGING RECEIPT OF THIS APPEAL.
I DO NOT WANT A TRANSCRIPT OF THE HEARING TO BE PRODUCED. I UNDERSTAND THAT THE BOARD WILL NOT REVIEW HEARING TESTIMONY.
DMV USE ONLY
Last Name
Date of Birth:
Corporate Name or DBA
Appeal Mailing Address (Street)
State Zip Code
City
State Zip Code
City
ATTORNEY FOR THIS APPEAL (if any)
Date of Each Hearing
Date of Decision/Order
Hearing Location(s)
Administrative Law Judge
Facility/Certificate Number
Case Number(s)
First Name M.I.
Type of Appeal (Chemical Test Refusal, License Denial, Inspection, Dealer, Repair Shop, etc.)
NYS Driver License
Client ID Number
Sex
o Male o Female
AA-33A (5/13)
Attorney Mailing Address (Street)
PAGE 1 OF 2
o $10 APPEAL FEE(S) RECEIVED o NO FEE RECEIVED
o CHECK o MONEY ORDER o AMOUNT: $ ______________
DMV
USE
ONLY
MM DD YYYY
MM DD YYYY
DATE:
STAY:
REQUIRED APPEAL INFORMATION
HEARING TRANSCRIPTS
REQUESTING A STAY
WHERE TO SEND AN APPEAL
DEADLINE TO FILE AN APPEAL
WHAT IS REQUIRED TO FILE AN APPEAL
WHAT IS THE SUBJECT OF YOUR APPEAL (Check the appropriate box.)
o
o
o
All correspondence for this appeal will be sent to the address(es) supplied on this appeal form. You must notify the Appeals Board in writing immediately of
any change of address that occurs after this appeal is filed.
o CHEMICAL TEST REFUSAL– DMV HEARING HELD
o DENIAL OF APPLICATION FOR DRIVER LICENSE, CERTIFICATE OR PRIVILEGE – NO DMV HEARING HELD
o FACILITY LICENSE OR CERTIFICATE, including INSPECTION STATION, INSPECTOR, DEALER, REPAIR SHOP – DMV HEARING HELD
o FATAL ACCIDENT, PERSISTENT VIOLATOR, FALSE STATEMENT– DMV HEARING HELD
o ALL OTHERS – including OTHER DETERMINATIONS MADE WITHOUT A DMV HEARING
Mail the appeal form and
appeal fee(s) to:
DMV APPEALS BOARD
P.O. BOX 2935
ALBANY, NY 12220-0935
Page 1/2
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