AUDIT APPEAL FORM FOR INTERNATIONAL
REGISTRATION PLAN REGISTRANTS
FOR OFFICE USE ONLY
$10 Appeal Fee received:
Date Received: / /
Check or Money Order #:
YOU MUST SEND THIS COMPLETED APPEAL FORM AND A $10 APPEAL FEE WITHIN 30 DAYS AFTER THE
DATE OF THE AUDIT FINDINGS LETTER THAT YOU RECEIVED. Please pay the appeal fee by money order or check,
payable to the Commissioner of Motor Vehicles. Print your Audit Number on your check or money order. Do Not Send
The U.S. Postal Service postmark date will be used to determine if you have met the 30-day filing requirement.
Send your completed appeal form and non-refundable $10 appeal fee to:
NYS DMV Appeals Board
DMV Appeals Processing Unit
PO Box 2935
Albany, NY 12220-0935
I affirm under penalty of perjury that all of the information on this form and all supporting documents submitted with this
appeal are true.
Print Name: __________________________________________
SIGN HERE: __________________________________________
TYPE or PRINT your information in the boxes below.
Name of the Business
IRP Account No.
MAILING ADDRESS (Number and Street)*
City or Town
PAGE 1 OF 2
Personal appearances to present arguments to the DMV Appeals Board are not permitted. Receipt of your appeal form
will be acknowledged in writing. If you do not receive an acknowledgment within 20 days of mailing this form, contact
the Appeals Board immediately at the address above or at
Attorney name and address, if applicable:
*All correspondence for this appeal will be sent to the address 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.
In the space below, state the reasons why you are filing this appeal. Type or print clearly. Do not leave this section blank.
READ AND SIGN THE CERTIFICATION AT THE BOTTOM OF THIS PAGE.
DMV USE ONLY