General Information

Dispute Information

Dispute Reason*

Comment*

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Requestor Information

Email*

First Name*

Middle Initial

Last Name*

License Type*

License Number

Relationship to Owner/Applicant*

Business Name *

Business Address

City

State

Zip Code

Business Telephone

Phone Number*

Relationship to Certifier*

Do you possess a DOB issued identification card ?*

Yes

DOB Issued ID#*

Summons Number*

Penalty Waivers & Reductions

If the violation is admitted and certified as corrected, it may be eligible for a penalty waiver or reduction. Penalty waivers and reductions are outlined in the DOB Penalty Schedule found in Title 1 of the Rules of the City of New York, Section 102-01. To request a cure or stipulation, check the applicable box below. For more information visit www.nyc.gov/DOBpenaltyschedule.

Cure (waiver): If the summons states a Cure Date, submit an acceptable Certificate of Correction to DOB by the Cure Date. If the Certificate of Correction is approved, a hearing will not be held, and no penalty will be imposed by OATH. If the Certificate of Correction is not approved, attend the hearing to dispute the violation or admit to the violation by paying the penalty before the scheduled hearing date.

CURE. I admit the existence of the violation(s) charged.

Cure Date

ATTENTION: To request a cure, the certifier must complete section three of the Certificate of Correction Affidavit (form AEU2). Failure to complete section three of the Certificate of Correction Affidavit (form AEU2) will result in a standard approval (non-cure).

Stipulation (reduction): If a pre-hearing stipulation is received and accepted, a reduced penalty of one-half the standard penalty may be imposed if an acceptable Certificate of Correction issubmitted to DOB by the compliance due date. If the Certificate of Correction is not approved, the penalty will be increased to the standard or aggravated penalty, whichever is applicable.

STIPULATION. I admit the existence of the violation(s) charged.

Stipulation Compliance Due Date

Comments

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