[NOTE: The following sample questionnaire is used with the New York Tenant Evictions Library.]

EVICTIONS QUESTIONNAIRE

Do you wish papers for -
__NONPAYMENT eviction
__HOLD OVER eviction
__stay execution of warrant [just identify premises and parties]
Type of premises -
__apartment [__a coop apartment]
__house
__office
__store
__other:

Str. Addr.:

City:
ZIP:
County:
Description (e.g., suite or apt. no., floor no., no. of rooms, area):



If an apartment:
__rent controlled
__rent stabilized
__on 6/30/74
__on 7/1/74 (after being destabilized for vacancy)
__on 7/1/74 (after being decontrolled for vacancy)
__after 7/1/74 (when vacancy ended rent control)
Rent Stabilization Assoc. No.: #
__subject to HUD's Sec. regulations
__make Housing Authority a party to collect subsidy portion of contract rent
__make Housing Authority a party because it objects to Certification of Basis for Eviction Proceeding
__neither rent controlled, rent stabilized nor subject to HUD Sec. 8
__community does not have ETPA or similar reg's
__building constructed after 1973
__building has less than 6 units
__coop apartment
__tenant does NOT reside in apartment
__building is a multiple dwelling
Multiple Dwelling Reg. No.:
Name of Mng. Agent:
Address:
Identify tenant -
Name(s):


__names are fictitious
__on public assistance
Address(es):


Any other address for service:

__there are Under-tenants
__"John Doe" and "Jane Doe"
Name(s):

__names are fictitious
Address(es):

Identify landlord -
Name:


__names are fictitious
Address [__business __residence]:


__corporation __partnership __LLC __individual
__owner __net lessee __co-tenant __managing agent

Who is to verify the petition -
__petitioner
__officer/partner of petitioner - name:
__an agent for petitioner - name:
__an attorney-in-fact - name:
__you as attorney [rarely proper]
Identify lease -
Date of lease:
Commencement date of lease term:
__amendments or extensions - date(s):
__name of original landlord (if not petitioner):
__was an oral agreement (not written)
__copy of lease to be appended to petition
__lease to be referred to by a term other "lease":

If a HOLD OVER proceeding -
Original termination date:
Length of lease term:
__lease terminated because of default
Date terminated:
Describe default:
Amounts sought in petition -
__(if HOLD OVER) tenant owes, in addition to use and occupancy, rent for period prior to termination date - amount and description:


Rent was payable on: __first day of month __other:

Enter total rent owed, including any late charges and other additional rent (but not interest): $
Describe:




__INTEREST on the rent to be sought - from what date:

__attorneys' fees sought - __in petition __in 3 Day Notice Amount: $
Month in which petition will be verified:

Hearing to be at: __9:30 A.M __other:

__3 Day Notice was given orally (not in writing)
__lease requires 5 Day Notice, not 3

__notice of petition is to require tenant's answer 3 days before return date

If not NYC -
Name of Court (in 2 lines for caption):

Street Address:
City:
Do you wish to prepare -
__ancillary documents (e.g., judgment and warrant) - warrant to be executed by __marshal __sheriff __other:

__affidavits of service - __personal service __other method
__ancillary letters
__notice of motion to restore to trial calendar