Fillable FREEDOM OF INFORMATION APPEAL FORM (New York Department of Motor Vehicles)

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FREEDOM OF INFORMATION APPEAL FORM (New York Department of Motor Vehicles)

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FREEDOM OF INFORMATION APPEAL FORM
Public Officers Law -- Article 6
FOR OFFICE USE ONLY
Appeal Case Number
Instructions:
•
You must file your appeal within 30 days of the date of denial of access to records.
•
You will be Notified in writing of the results of your appeal.
What record(s) did you request that was denied? Describe here, or attach a copy of your original request and any DMV reply:
State your reasons for appealing on the back of this form or attach your statement.
Fill in the information below
(Type or print clearly)
Last Name First M.I. Date of Denial (Mo./Day/Year)
Corporate Name (if applicable) Foil Request #
Mailing Address (Include Street & No.) City/Town State Zip Code
If you are represented by an attorney in this appeal, complete this section.
Last Name First M.I. Date of Denial (Mo./Day/Year)
Corporate Name (if applicable) Foil Request #
Mailing Address (Include Street & No.) City/Town State Zip Code
Send your appeal to:
Department of Motor Vehicles
Appeals Processing Unit
P.O. Box 2935
Albany, New York 12220-0935
Be sure to complete the certification on Page 2 of this form
PAGE 1 of 2
AA-33FI (1/16)
reset/clear
Type or print the reason for your appeal: Print or type the reason or basis for your appeal in the space
provided below. Attach additional pages, if necessary. Read and sign the certification at the bottom of this page.
CERTIFICATION: I certify that the information I have given on this Appeal form is true, to the best of my knowledge.
Sign Here t Date
(Sign name in full)
AA-33FI (1/16)
PAGE 2 of 2
Last Name First M.I.
reset/clear
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FREEDOM OF INFORMATION APPEAL FORM (New York Department of Motor Vehicles)

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Completed 12 August 2021

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