Get Ny Medallion Storage Receipt 2021-2026

Filling out the NY Medallion Storage Receipt is an important step for medallion owners who need to place their credentials in storage. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the NY Medallion Storage Receipt and open it in your browser.
2. Enter the name of the medallion owner in the designated field at the top of the form.
3. In the section labeled 'Date placed into storage', input the appropriate date using the format MM/DD/YYYY.
4. Fill in the Medallion number in the specified field. This should be the unique number associated with your medallion.
5. Provide the Rate Card number in the related field, following the same guidelines as above.
6. In the 'Reason for placing credentials in storage' section, clearly specify your reason, ensuring that it is detailed and accurate.
7. If you are the person who is placing the credentials in storage, sign your name in the 'Placed in Storage by' section. After signing, print your name and provide the date in the designated fields.
8. If you are an agent submitting the form, ensure you attach a statement on your letterhead confirming your status as the agent for the medallion owner.
9. Once you have completed all sections of the form, review your information for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Complete your NY Medallion Storage Receipt online today to ensure your credentials are properly managed.