To Report A Lost Or Stolen Permit Form

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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 ____________________________
(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 210.45, 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. Making a punishable false written statement is a Class A misdemeanor.
Permit Holder's Signature (or guardian)
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.
On-Site pickup for permits call (718) 433-3100 for ID requirements
Special Instructions:
NYC Department of Transportation
Permits & Customer Service (PPPD Unit)
30-30 Thomson Avenue, 2nd Floor
Long Island City, NY 11101
T: (718) 433-3100, TTY (212) 504-4115


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Parent category: Legal