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COMPLAINT REPORT FOR OFFICE USE ONLY. Division of Vehicle Safety Facility Number Case INSTRUCTIONS: (Before you file your complaint, please try to settle this matter with the facility.) Number Check the appropriate box to show the type of complaint involved. CSR. o Vehicle repair o Vehicle inspection o Vehicle purchase Region County We can only accept complaints about repairs up to 90 days or 3,000 miles (whichever comes first) after the date repairs were completed. The only exception is a written warranty that may Case exceed these time and/or mileage limits. Number PLEASE PRINT OR TYPE ALL ENTRIES AND USE BLACK INK. Your Name of Name Facility Address - Number Address - Number and Street and Street City State Zip Code City State Zip Code Telephone Number (Include area code) Telephone Number Home ( ) Work ( ) (Include area code) ( ).

Did the inspection station refuse to give you an appointment date in writing? o. Yes . o. No 3. Were you told or led to believe that repairs necessary to pass inspection had to be made at the same station? o. ... New York State Department of Motor Vehicles Subject: VS-35 \(8/19\)

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