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Get NY TLC Termination of Affiliation Form 2016-2024

On at: www.nyc.gov/tlc or contact our Call Center at 718-391-5501. HOW TO SUBMIT A TERMINATION OF AFFILIATION FORM: You may either fax this form and any supporting documents to 718.391.5786 or you may email a scanned version of this form and any supporting documents to terminate@tlc.nyc.gov. To: Applicant Licensing - Owner Section From: License Number / Permit Number: ___________ Name:________________________________ Address: ________________________________________________________________.

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