Form APP16 "Appeal Application" - New York City (Haitian Creole)

Form APP16 is a New York City Office of Administrative Trials and Hearings form also known as the "Appeal Application". The latest edition of the form was released in April 1, 2018 and is available for digital filing.

Download an up-to-date Form APP16 in PDF-format down below or look it up on the New York City Office of Administrative Trials and Hearings Forms website.

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Download Form APP16 "Appeal Application" - New York City (Haitian Creole)

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Appeals Unit
66 John St., 10th Floor
New York, NY 10038
APLIKASYON POU KONTESTASYON
Ou DWE itilize fòm sa a pou konteste. Tanpri li enstriksyon yo avèk atansyon. Lè ou fin ranpli fòm nan poste li
ansanm ak nenpòt dokiman sipò nan adrès ki anwo a. Tanpri kole yon kopi desizyon odyans la ak li.
Enfòmasyon Konsènan Sitasyon a (yo) ak Moun Ki Ranpli Fòm Sa a
Si gen yon reprezantan, Hearings Divisyon pral poste desizyon pou kontestasyon nan bay reprezantan an nan adrès reprezantan an.
Si li pa gen yon reprezantan, Hearings Division pral poste desizyon an nan adrès ki anba a.
__________________________________________________
Nimewo Sitasyon (yo) (itilize yon paj an plis si ou bezwen plis plas):
__________________________
________________________
Non ki sou Sitasyon an (yo):
Non moun k ap fè Demand la:
____________________________________________
_____________________
Relasyon li ak Defandè a
(si sa aplikab):
____________________________________
Adrès Postal:
(Reprezantan ki Anrejistre yo dwe tache Fòm Otorizasyon pou Prezante)
______________________________________
___________________________________
Vil, Eta:
Adrès Postal:
___________________________________
____________________
_________
Kòd Postal:
Vil, Eta:
Kòd Postal:
________________________________
________________________________
Nimewo Telefòn:
Nimewo Telefòn:
___________________________________
____________________________________
Adrès Imèl:
Adrès Imèl:
Tcheke ti bwat la si yo te sispann oswa anile lisans Defandè a (si sa apwopriye):
Men Poukisa Desizyon an pa Bon
Ou fèt pou montre desizyon odyans la pa te bon paske gen enfòmasyon ki pa te kòrèk, te gen yon erè nan fason yo te aplike lwa a,
oswa toulède. Ou kapab sèlman depann sou enfòmasyon, prèv, ak agiman yo te itilize nan odyans la. Inite Kontestasyon an pa pral
konsidere nouvo enfòmasyon, prèv, oswa agiman y ap deside sou kontestasyon an. Mete akizasyon w ap konteste yo.
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(Tache lòt paj, si li nesesè.)
(TOUNEN PAJ LA. OU DWE RANPLI PAJ APRE A)
App16 appeals - uniform appeal application 4_1_18-Haitian Creole
Appeals Unit
66 John St., 10th Floor
New York, NY 10038
APLIKASYON POU KONTESTASYON
Ou DWE itilize fòm sa a pou konteste. Tanpri li enstriksyon yo avèk atansyon. Lè ou fin ranpli fòm nan poste li
ansanm ak nenpòt dokiman sipò nan adrès ki anwo a. Tanpri kole yon kopi desizyon odyans la ak li.
Enfòmasyon Konsènan Sitasyon a (yo) ak Moun Ki Ranpli Fòm Sa a
Si gen yon reprezantan, Hearings Divisyon pral poste desizyon pou kontestasyon nan bay reprezantan an nan adrès reprezantan an.
Si li pa gen yon reprezantan, Hearings Division pral poste desizyon an nan adrès ki anba a.
__________________________________________________
Nimewo Sitasyon (yo) (itilize yon paj an plis si ou bezwen plis plas):
__________________________
________________________
Non ki sou Sitasyon an (yo):
Non moun k ap fè Demand la:
____________________________________________
_____________________
Relasyon li ak Defandè a
(si sa aplikab):
____________________________________
Adrès Postal:
(Reprezantan ki Anrejistre yo dwe tache Fòm Otorizasyon pou Prezante)
______________________________________
___________________________________
Vil, Eta:
Adrès Postal:
___________________________________
____________________
_________
Kòd Postal:
Vil, Eta:
Kòd Postal:
________________________________
________________________________
Nimewo Telefòn:
Nimewo Telefòn:
___________________________________
____________________________________
Adrès Imèl:
Adrès Imèl:
Tcheke ti bwat la si yo te sispann oswa anile lisans Defandè a (si sa apwopriye):
Men Poukisa Desizyon an pa Bon
Ou fèt pou montre desizyon odyans la pa te bon paske gen enfòmasyon ki pa te kòrèk, te gen yon erè nan fason yo te aplike lwa a,
oswa toulède. Ou kapab sèlman depann sou enfòmasyon, prèv, ak agiman yo te itilize nan odyans la. Inite Kontestasyon an pa pral
konsidere nouvo enfòmasyon, prèv, oswa agiman y ap deside sou kontestasyon an. Mete akizasyon w ap konteste yo.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
(Tache lòt paj, si li nesesè.)
(TOUNEN PAJ LA. OU DWE RANPLI PAJ APRE A)
App16 appeals - uniform appeal application 4_1_18-Haitian Creole
Eta Ou Dwe Pran Pou Hearings Division Ka Deside Sou Kontestasyon a
1) Èske Hearings Division pral resevwa kontestasyon ou a avan dat limit ki anba la a?
WI
NON
N ap bay kontestasyon a refi si nou resevwa li plis pase 30 jou apre Dat Desizyon an amwenske yo te akòde yon demann pou
plis tan nou te resevwa a tan. Si nou te voye desizyon an pa lapòs, dat limit pou kontestasyon an ap 35 jou apre Dat Desizyon
an. Dat Desizyon an ap devan desizyon odyans la. Defandè yo dwe ranpli Etap 2, 3a, ak 3b anba la a. Ajans aplikasyon lalwa
yo dwe ranpli Etap 4 anba la a.
POU DEFANDÈ YO SÈLMAN - OU DWE RANPLI PRÈV PEMAN AK PRÈV SÈVIS ANBA LA A
2) Ou DWE tcheke wi akote youn nan chwa yo ki anba la a pou ou kapab depoze yon kontestasyon:
• Ou te peye tout sanksyon an nèt oswa yo ajans la te renonse tout sanksyon an.
WI
NON
Ou dwe peye tout sanksyon an nèt avan y ap ka deside sou kontestasyon an.
Ka pou Machin ki Disponib pou travay ak Taksi yo: Peman oswa renonsyasyon pa obligatwa si sitasyon yo se pou yon
vyolasyon yon lwa oswa regleman Komisyon Taksi ak Limouzin (Taxi & Limousine Commission) aplike.
Ka pou Endividi: Menmsi yo te renonse tout peman pou sanksyon an, si desizyon Hearing Officer a mande pou peye
restitisyon an, defandè a dwe depoze montan restitisyon an ak Depatman Afè Konsomatè (Department Of Consumer Affairs).
Plan Peman: Si defandè a te antre nan yon plan peman ak ajans ki responsab pou touche peman pou amann oswa sanksyon
yo, w ap bezwen tache yon kopi plan peman an.
• Defandè a kalifye pou fè sèvis kominotè tan pou li peye yon sanksyon sivil, li te kontakte CCI pou
WI
NON
chwazi fè sèvis kominotè, epi li te fè pwosesis pou admisyon an.
Pou dosye ki kalifye pou Sèvis Kominotè anba Lwa Refòm Jistis Kriminèl la sèlman, defandè a pa bezwen peye yon sanksyon
oswa fè Sèvis Kominotè pou konteste depi defandè a te kontakte CCI epi fè pwosesis pou admisyon an ak li. (W ap jwenn
enfòmasyon pou kontakte CII sou do desizyon odyans la.)
• Defandè a ap mande pou renonse peman an paske l ap yon fado finansyè pou li peye pandan y
WI
NON
ap deside sou kontestasyon an.
Ou DWE tache prèv difikilte, tankou premye de (2) paj deklarasyon taks sou revni Federal defandè a, epi eksplike anba a
kijan li t ap yon fado finansyè pou defandè peye sanksyon an.
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3a) M ap voye yon kopi kontestasyon an bay (tcheke ti bwat ki akote non ajans w ap voye yon kopi kontestasyon an bay li):
Ka Bilding yo:
Asenisman, Resiklaj, Afichaj
Ka Kòd Dife (ak fe atifis ladan):
Dosye Boutèy Alkòl ki Louvri
Ka Kòd Sante, Restoran,
Dept. of Buildings
ak Machin ki Abandone:
FDNY Legal Enforcement Unit
New York City Police Dept.
Vandè Manje, ak SRO
Administrative Enforcement
Department of Sanitation
Bureau of Legal Affairs
Attn: Legal Bureau
DOHMH General Counsel
th
th
th
Unit 280 Broadway, 5
Floor
Bureau of Legal Affairs
9 Metrotech Center, 4
Floor
1 Police Plaza, Room 1406
42-09 28th Street, 14
Floor CN-30
th
New York, NY 10007
125 Worth Street, 7
Floor
Brooklyn, NY 11201
New York, NY 10007
Long Island City, NY 11101-4132
New York, NY 10013
Ka Lè, Bri, Dlo, RTK, HazMat
Ka Kòd Transpò ak Kyòs Jounal:
Ka Minisipalite Depatman Pak, Vil Hudson
Ka Telefòn Piblik:
ak Dlo Ize:
Dept. of Transportation
River ak Battery:
DOITT Customer Service Coordinator
DEP General Counsel
c/o Asst. Commissioner, HIQA
Parks Dept. Counsel’s Office
Public Pay Telephones
th
th
th
59-17 Junction Blvd, 19
Floor
55 Water Street, 7
Floor
The Arsenal, 830 5
Avenue
75 Park Place, 9th Fl.
Flushing, NY 11373-5108
New York, NY 10041
New York, NY 10065
New York, NY 10007
Ka Mache:
Ka Konsomatè ak Vandè Jeneral:
Ka Sit Istorik:
Ka pou Machin ki Disponib pou travay ak
Business Integrity Comm., Gen. Counsel
Dept. of Consumer Affairs, General Counsel
Landmarks Preservation Commission
Taksi yo:
th
th
100 Church Street, 20
Floor
42 Broadway, 8
Floor
Municipal Bldg., 1 Centre St., 9th Fl., North.
NYC Taxi & Limousine Commission
New York, NY 10007
New York, NY 10004
New York, NY 10005
Falchi Bldg., 31-00 47th Ave.
Long Island City, NY 11101
N ap bay yon kontestasyon refi amwenske ou voye yon kopi konplè aplikasyon pou kontestasyon an, ki gen nenpòt atachman, bay ajans aplikasyon
lalwa ki reponsab pou sitasyon an (yo). Nòt: Si defandè ap mande yon renonsyasyon akòz difikilte, pa voye kopi prèv difikilte a bay ajans aplikasyon
lalwa ki responsab pou sitasyon an (yo).
3b) Pou bay prèv ou te voye yon kopi kontestasyon an bay ajans la, tcheke ti bwat ki akote non ajans aplikasyon lalwa ki
responsab pou sitasyon an (yo) nan Etap 3a anwo a EPI ranpli ak siyen deklarasyon ki anba la a.
MWEN SE
_____________________________, M AP VIV NAN
_____________________________________,
[ekri non ou an lèt detache]
[adrès ou]
EPI MWEN SÈTIFYE AVÈK POSIBLITE SANKSYON POU FO TEMWAYAJ, MWEN GEN OTORIZASYON POU SOUMÈT DEMANN SA A, EPI
SELON TOUT SA MWEN KONNEN TOUT ENFÒMASYON MWEN METE SOU FÒM SA A AK NAN DOKIMAN YO KI VINI AK LI YO, SI
GENYEN, SE VERITE EPI NAN DAT
______________MWEN TE VOYE YON KOPI KONTESTASYON SA A BAY AJANS APLIKASYON
[
]
dat
LALWA KI RESPONSAB POU SITASYON AN (YO) NAN ADRÈS LI KI ANWO A KOTE MWEN TE DEPOZE LI NAN YON BWAT LÈT SÈVIS
LAPÒS AMERIKEN OSWA AK LÒT SÈVIS POSTAL.
SIYATI OU:
____________________________
AJANS APLIKASYON LALWA YO SÈLMAN
4) Ajans aplikasyon lalwa yo dwe kote yon afimasyon separe ki endike yo te voye dokiman an bay defandè a.
App16 appeals - uniform appeal application 4_1_18-Haitian Creole
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