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Get NY PVO-0100 2013

Want to request an appeal of your hearing decision. If you accept the Judgeʼs decision and are going to pay or have paid the amount imposed, you should not submit this form. SECTION A. RESPONDENT INFORMATION (Please Print) Daytime 1. Name: ___________________________________________________________ Phone Number: ________________________ FIRST LAST 2. Address: ________________________________________________________________________________________________ APT.NO. NUMBER AND STREET 3. I am:.

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