SECTION C: REFUND REQUEST INFORMATION
SECTION B: PAYMENT INFORMATION
SECTION A: CONTACT/REGISTRANT INFORMATION
SECTION D: BOOT OR TOW FEE REFUND INFORMATION
SECTION E: CERTIFICATION
PARKING / CAMERA VIOLATIONS REFUND FORM
Mail to: NYC Department of Finance - Refunds Unit, 59 Maiden Lane, 20th Fl., New York, NY 10038
Plate Number:
Violation #:
I am requesting a refund of boot or tow fees because:
1.
q
The vehicle was booted or towed in error.
2.
q
The violations were dismissed in a hearing after the vehicle was redeemed.
I hereby affirm that I am entitled to a refund in the amount of $
________________
for the reason(s)
claimed above. The attached documents, if any, submitted in support of my claim are unaltered.
________________________________________________ ______________________________
Signature Date
Daytime
1. Name: __________________________________________________________ Phone Number: ________________________
F
IRST LAST
2. Address: _______________________________________________________________________________________________
N
UMBER AND STREET CITY STATE ZIP CODE
3. I am the (check one): q Registered Owner q Not the Registered 4. Email: ____________________________
of the vehicle Owner of the vehicle
If you are requesting a boot or tow fee refund, a copy of the receipt or payment voucher must be attached.
Please note that, in order to claim a refund, the related summons(es) must have been dismissed.
PV-0101 Rev. 11.16.2018
Visit Finance at nyc.gov/finance
NEW YORK CITY DEPARTMENT OF FINANCE l PAYMENT OPERATIONS DIVISION l REFUNDS UNIT
I am requesting a refund because:
1.
q
The amount paid was reduced by a hearing or an appeal hearing after payment.
(A copy of your hearing or appeal board determination must be attached.)
2.
q
I paid the same violation more than once.
3.
q
The violation was not a parking or camera violation. (It was a traffic violation or a violation issued by another
agency or jurisdiction.)
4.
q
Other (Please explain. Example: I paid more than the amount due; etc.)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
State:
Please see instructions for further details and complete all sections below. Keep a copy for your records.
Paid By
(Check One)
:
1.
q
Credit/Debit Card
(Confirmation or Receipt #: ____________________)
q
Other: ___________________________
Please Print or Type:
1. REGISTERED OWNER: Finance will issue a refund of parking and/or camera violation
overpayments to the registered owner of the vehicle within 30 days. The registered owner
does not need to file this form to claim a refund of these overpayments. A check will auto-
matically be generated and mailed to the registrant’s address on file with the Department
of Motor Vehicles.
2. OTHER THAN THE REGISTERED OWNER: If an individual other than the registered
owner made payment, (s)he must complete this form to claim the refund. If payment was
made at one of the Business Centers, you must attach a copy of the payment receipt.
3. BOOT OR TOW REFUNDS: You must complete this form to claim a refund. Refunds are
not generated automatically. To avoid processing delays, please include a copy of the tow
redemption receipt or payment voucher.
4. CREDIT/DEBIT PAYMENT: If you made the payment using a credit or debit card, you
must include:
l A copy of the payment receipt or confirmation number, and
l A daytime phone number.
Please note that all refunds will be issued in the form of a paper check.
5. Please provide all information requested on this form, including your vehicle plate and
violation numbers.
GENERAL INSTRUCTIONS
Parking and/or Camera Violations Refund Form Page 2
For Parking or Camera Violation Refund Inquiries,
Visit Finance at:
nyc.gov/parkingrefunds
Or
Call 311
