Request For Hearing by Mail at The Transit Adjudication Bureau - Violation #120023779

Request for Hearing by Mail
at the Transit Adjudication Bureau
This form allows you to dispute a Transit Adjudication Bureau (TAB) Notice of Violation summons without having to appear
in person. You must send this form and all evidence you wish to be considered so that it is received at TAB on or before
the hearing date on your Notice of Violation summons.
A Hearing Officer will review your statement and all evidence that you submit. TAB will mail you the Hearing Officer’s
decision. TAB will not send decisions via email. If you have not received a response within three weeks of sending this
request, please contact TAB at (347) 643-5805 Monday to Friday 8:00 AM to 4:45 PM.
Send by mail with all evidence to: Transit Adjudication Bureau PO Box 29133 Brooklyn, NY 11202-9133
OR
Send by email with all evidence attached to: [email protected]
* Indicates required fields.
Respondent Information
Full Name*: Jerod Packard D 11/22/2022
Last* First* M.I. Date*
Mailing Address*: 40 W 127th Apt. 1

(your decision will Street Address* Apartment/Unit #
be mailed here) New York NY 10027
City* State* ZIP Code*
Phone:
Social Security Number:
Date of Birth*: 03/17/1998
Email:
Employer Name:
Employer Address:
Violation Information
If you do not know the Notice of Violation #, please call (347) 643-5805 Monday to Friday 8:00 AM to 4:45 PM.
Notice of Violation #*: 120023779
Date of Offense:
Hearing Date:
Complete this Section for “Entered without Payment” Violation

If you used a MetroCard, you must attach a photo of the back of the MetroCard showing the serial number.
MetroCard #:
OMNY Transit Account #:
Note: If you used OMNY to pay your fare, please include your OMNY Transit Account Number. Only the OMNY Transit
Account Number can verify your payment. Bank statements and photos cannot be verified without the OMNY Transit Account
Number.
To obtain the OMNY Transit Account Number by telephone: Please call OMNY Customer Service at (877) 789-6669
Monday to Friday from 8:00 AM to 5:00 PM. When prompted for a credit card number, press “0” to be transferred to a
representative who will ask your card number and expiration date of the card used to travel. The representative will provide
you with your Transit Account Number.
To obtain the OMNY Transit Account Number online: Visit https://omny.info/ to create an OMNY account with a valid email
address. Add the credit card information and the Transit Account Number will appear in your “Wallet” on the website.
1 Rev. 07/2021
Complete this Section for Violation on the Select Bus
Location where you
boarded the Select Bus:
Why should the Notice of Violation be dismissed?

(Your statement should be detailed and fully explain the basis of your defense.)
I am providing the following statement to contest this Notice of Violation*:

I was entering the 145th subway station when I noticed an officer opening the side gate to let a
couple of pedestrians in. When I followed, the officer said, "I didn't say YOU could come in," in a
manner that I interpreted as joking. When I misread the situation and kept walking, the officer
immediately put hands on me as well as one of the pedestrains he let through. Both of them
were using so much force that I dropped my wallet and scarf on the ground near the entrance.
Despite stating multiple times that my things were on the ground they continued to pull me
further away from where my wallet and scarf was. I decided to keep with verbal reiterations that
the only reason I continued to attempt to stand my ground in that one spot was so that my wallet
wouldn't get stolen or forgotten. This did not resolve the matter. They continued to use excessive
force, both the officer and the pedestrian, so much so that they were grabbing me by a fanny
pack I had around my neck and back, and this began to choke me. There was no "lawful order"
given, as he just commented in a vague way and then proceeded used excessive physical force.
There was an associated "disorderly conduct" charge in regard to this incident that was
dismissed in court, which should serve as support to my contestation of the charges here. No
violation was found to have occured in the court of law, and no attempt was made on the officer's
part to de-escalate the situation.
Certification
✔ By checking this box, I understand that I have the right to be represented by an attorney in this matter.*
✔ By checking this box, I understand that I waived my right to an in person hearing.*
By entering my name, I affirm under penalty of perjury that to the best of my knowledge all the statements in this form are true and
correct.
Signature
(please type)*: Jerod Packard Date*: 11/22/2022
If submitting by email, please attach all evidence you wish to be considered to this email.
For “Entered without Payment” violations, please send a photo of the back of the
MetroCard showing the serial number.
2
Rev. 07/2021

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Request for Hearing by Mail

at the Transit Adjudication Bureau

* Indicates required fields.

Mailing Address*: 40 W 127th Apt. 1

Complete this Section for “Entered without Payment” Violation

Why should the Notice of Violation be dismissed?

I am providing the following statement to contest this Notice of Violation*:

✔ By checking this box, I understand that I waived my right to an in person hearing.*

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