NYC 9/11 Public Portal Document
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State of New ^rk )
County of )
I , being duly sworn, depose and say that I am the respondent cited in the
PRINT YOUR NAME
Notice of Violation and that I admit the existence of the violation(s) described in the Notice of Violation.
I have corrected all said violations as ordered by the Commissioner
Check one O'"
□ I have only corrected Rule Number(s) _
and will attend hearing on scheduled date.
(The respondent certifies that all violations have been corrected if no box is checked.)
I have attached legible copies of any and all bills, receipts and other proof of correction to this certification as required.
SIGNATURE
(Sign only before a notary)
TO BE COMPLETED BY NOTARY
County of Registration Number SEAL
YVETTE KEYES
Sworn to before me this Notary Number NOTARY PUBLIC. State of NewYork
No. 31-4935341
Commission Expires^cemSS^^’J^^J^M aTlt?^
Signature of Notary
The Fire Commissioner reserves the right to reject any Certificate of Correction that is incomplete. False certification
is punishable by a fine of not le» than $1,000 nor more than $5,000 and/or up to 6 months imprisonment pursuant to
Administration Code Section 15-220.1
CERTIFBGAT INSTRUCTIONS
For first offonsos:
1. ALL offendere must coitect the violation(s) cited on the NOTICE OF VIOLATION.
2. All offenders must complete the Certificate of Correction above and have it notarized. Do not detach above certificate from this page.
3. Attach legible copies of any and all bills, receipts and/or other proof of compliance to this Certificate of Correction (see correction
requirements on reverse of green copy) and submit them along with this Certificate.
4. Return the completed Certificate of Correction with all appropriate documentation attached to the Bureau of Fire Prevention,
Enforcement Unit, 250 Livingston Street, Brooklyn, New Mark 11201-5884 by the close of business on the date indicated on
the NOTICE OF VIOLATION for return of the certificate. (See reverse side for return date)
5. Respondents will be notified by mail if their Certificate of Correction has been disapproved and of the appropriate action to take
to correct same.
6. If it is impossible to correct any or all violations within the time indicated, you may be eligible for a stipulation extending the time
to correct. A request for a stipulation extending compliance time must be made at the hearing and is subject to the approval of
the Fire Department and the Environmental Control Board. (ECB).
Z If you properly certify that ALL violations have been corrected, you will be excused from appearing at the Scheduled ECB hearing
and no penalty will be Imposed.
8. If you fail to comply with (7) above or if your are a repeat offender, you will be required to attend the ECB hearing designated
on the NOV and bring any and all proof of correction to the hearing.
eCfi HEARING OFRCES
If you are required to attend an ECB hearing, check the location and time indicated on the face of the NOV and note the address below:
* Manhattan/Bronx: 1250 Broadway, 7th Fl. (212) 971-3600 ★ Queens: 91-14 Merrick Blvd., eth Fl. (718) 297-1080
* Brooklyn: 233 Schermerhorn St., 11th Fl. (718) 858-1305 * Staten Island: 350 St. Marks PL. - 4th Fl. St. George, (212) 971-3600
NYC-WTC_000168914
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