Request For A New Hearing After A Failure To Appear

ADVERTISEMENT

66 John St., 10th Floor
For Internal Use Only
New York, NY 10038
Tel: 1-844-OATH-NYC
 NSL Mailed
or 1-844-628-4692
Fax: 1-212-436-0715
Date: ____________
Request for a New Hearing After a Failure to Appear
Hearing
Officer: _______________
(Motion to Vacate a Default)
Date: _____________
 Grant
This request may only be made once.
I/O Req’d Yes  No 
A separate request must be made for each ticket.
 Grant w/in 45 days
Please read the instructions carefully.
 Abandoned
 No Standing
Answer every question in the space provided. Fill out both sides.
 Deny 1 2 3 4 5 6 7 N/A
Please attach each document that is requested or the request will be denied.
Notes:
Registered Representatives must attach completed Authorization to Appear Form.
Information About the Person Completing This Form
If the request is granted, a new hearing date will be mailed to the addresses listed below.
____________________________________________________________________________________
Name:
___________________________________
________________
________
Mailing address:
City, State:
Zip code:
_________________________________
_____________________________
Telephone number:
Email address:
 Yes
 No
Are you the named Respondent on the summons/notice?
If you are not the named Respondent, you must answer the following questions:
a)
Check the box that best describes who you are:
 Owner of property/business
 General/Managing agent
 Employee of respondent
 Partner/officer of respondent company
________________
 Other (friend, relative, etc…), describe
 Attorney
_______
 Registered representative, registration no.
 Yes
 No
b)
Are you authorized to represent the Respondent?
_______________________________________
c)
What is the name of the person who asked you to make this request?
d)
What is that person’s relationship to the Respondent? For example, if the summons/notice names a corporation as the Respondent, tell
__________________________________________________
us what that person’s job or title is at the corporation.
Information About the Summons/Notice and Respondent
________________________________________________________
Summons/notice number (only one number per form):
________________________________________
Name of Respondent, exactly as it is written on the top of the summons/notice:
__________________________________________________________________________________________
__________________________
Respondent’s current mailing address (If you do not include this address, your request will be rejected):
__________________________________________________________________________________________
________________
______
______
City, State:
Zip Code:
On what date did the Respondent first learn about this summons/notice?
____________________________________________________
How did the Respondent learn about this summons/notice?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(TURN OVER. YOU MUST COMPLETE THE NEXT PAGE)
OATHECB SMP10 rev. 1/1/16

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical
Go
Page of 2