__NONPAYMENT eviction
__HOLD OVER eviction
__stay execution of warrant [just identify premises and parties]

__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:

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):

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]

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:

__(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: $

Name of Court (in 2 lines for caption):

Street Address:
City: