Transcription of To Report a Lost or Stolen Permit (Please print all …
1 NYC department of TransportationPermits & Customer Service (PPPD Unit) 30-30 Thomson Avenue, 2nd FloorLong Island City, NY 11101 T: (718) 433-3100, TTY (212) 504-4115 To Report a Lost or Stolen Permit ( please print all the information requested) Permit Holders Name: _____ Date of Birth: _____ Telephone#: _____ Home Address: _____ Apartment #: _____ City: _____ State: _____ Zip Code: _____ Permit Type? City _____ State _____ (Rectangle/Dashboard) (Blue or Red Hangtag/Rearview mirror) Permit #(s) if known ___ _____ _____ Was Permit lost? _____ Stolen ? _____ License Plate#_____ Write a brief explanation below of why the Permit is missing: _____ I declare, under penalties of the penal law Section , that the statements contained herein are, to the best of my knowledge and belief, true and correct and that I have not knowingly and willfully made a false statement or given information which I know to be false.
2 Making a punishable false written statement is a Class A misdemeanor. _____ _____ Permit Holder's Signature (or guardian) Date Note: The Permit holder must file a Report with the local police precinct where the incident occurred and obtain a police incident information slip. please make sure that the incident Report states the nature of the crime and identify the type of Permit as: NYC Disability Parking Permit or a NYS Hangtag as Lost or Stolen . This slip must be sent with this completed form to the Parking Permits for People with Disabilities (PPPD) Unit at the address listed below. Special Instructions: On-Site pickup for permits call (718) 433-3100 for ID requirements
