Fillable Printable Form AA-71 - Vehicle Dealer Request for Adjudicatory Proceeding - New York

Form AA-71 - Vehicle Dealer Request for Adjudicatory Proceeding - New York

AA-71 (2/15)

Franchised Motor Vehicle Dealer

REQUEST FOR ADJUDICATORY PROCEEDING

Division of Safety & Business Hearings

Telephone: (518) 474-1509

Fax: (518) 473-8505

INSTRUCTIONS FOR REQUEST

1) All documents relevant to the claim(s) made in this request, including all correspondence between the dealer and franchisor,

must accompany this request when it is filed with the Commissioner. Include a copy of the current franchise agreement that

exists between the dealer and the franchisor, and a copy of the certificate of service (see Instruction #2). Submit to:

NYS Department of Motor Vehicles

Div. Safety and Business Hearings, Room 424A

6 Empire State Plaza

Albany, NY 12228

2) At the time this request is filed with the Commissioner, a true copy of this request, with copies of all documents filed with it,

must be served upon the franchisor in any manner specifically permitted under the terms of the franchise agreement or, if no

such manner is specified, then via certified mail, return receipt requested, addressed to the officer or employee of the

franchisor from whom the dealer has received correspondence relevant to the claims made in this request.

3) This request must be accompanied by a non-refundable filing fee of two thousand dollars ($2,000). Attach a certified check or

money order payable to the Commissioner of Motor Vehicles.

4) In a short, plain statement present the facts that support your claim that the franchisor has violated one or more specific provisions

of Article 17-A Franchised Motor Vehicle Dealer Act. Also, describe your request for a specific remedy other than damages.

(Use additional sheets as necessary.)

Date

Please Sign Here

Name: ___________________________________________ AKA/DBA_________________________________________

Address

(include number & Street) ____________________________________________________________________________

City _____________________________ State _____ Zip Code _____________ Telephone # _______________________

Dealer Certificate of Registration No.: _____________________ Represented by: ____________________________________

Franchisor ___________________________________________________________________________________________

Address

(include number & Street) ___________________________________________________________________________

City _____________________________ State _____ Zip Code _____________ Telephone # ______________________

Represented by (if known): _______________________________________________________________________________

Address

(include number & Street) ____________________________________________________________________________

City _____________________________ State _____ Zip Code _____________ Telephone # ______________________

Requests a New York State Department of Motor Vehicles Adjudicatory proceeding with:

COMPLETE THE INFORMATION REQUESTED BELOW. PLEASE PRINT.

( )

Your attention is directed to the automatic stay provisions, without bond, under Vehicle and Traffic Law Sections 463(2)(e)(1) and

465(7).

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