Form Aa-3.3 - Application To Reopen Default Conviction
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1
2APPLICATION TO REOPEN DEFAULT CONVICTION
TRAFFIC VIOLATIONS DIVISION
dmv.ny.gov
Only use this application if you have been convicted by default of a violation, which means that you failed to answer your traffic ticket or
you failed to appear at your scheduled hearing for a valid reason and you now are requesting to have a hearing.
Do not use this form if you were convicted at a hearing or pled guilty to this ticket.
(For additional instructions/information see page 2)
Instructions:
1. You must use a separate application for each ticket.
2. If submitting more than one application, send all applications in one envelope.
3. If your application was previously denied, do not submit another application to reopen the default conviction.
4. You must attach copies of any documents necessary to support your reasons for not responding to the ticket.
5. If this is regarding an Operating Without Insurance violation, see page 2.
6. Sign and date the application.
Submit your application and supporting documents by mail to:
Traffic Violations Division, P.O. Box 2095 - Albany, NY 12220
Failure to sign and complete ALL sections of this form will result in the denial of your request to reopen your default conviction.
If your request is denied, you will not be able to resubmit the application.
Name (Last, First, MI)
NY Client ID No., if available
Date of Birth (Month/Day/Year)
/
/
CURRENT MAILING ADDRESS
Street
Apt. No.
City
State
Zip Code
E-mail Address (optional)
Daytime Phone Number (optional)
Ticket No.
Date of Violation (Month/Day/Year)
/
/
Describe violation (for example, speeding, driving without insurance)
I DID NOT RESPOND to the ticket and/or notice because: (if necessary, attach additional 8 ½ x 11 page)
Read the statement below; sign your name, and write the date you signed this form.
I affirm under penalty of perjury that all of the information above and all supporting documents are true, and that no prior application
has been made with respect to this ticket.
X
/
/
____________________________________________________________ Date_____________________________
Signature
PAGE 1 OF 2
AA-3.3 (4/16)
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