Application For A Rent Reduction
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1
2Docket Number:
State of New York
Division of Housing and Community Renewal
Office of Rent Administration
Web Site:
Application For A Rent Reduction
Based Upon Decreased Building-Wide Service(s)
1. Mailing Address of Tenant:
2. Mailing Address of Owner:
Name:
Name:
Number/Street:
Apt. No.:
Number/Street:
City,
City,
State, Zip Code:
State, Zip Code:
Telephone No.: Bus. (
)
Telephone No.: (
)
Res. (
)
3. Subject Building (if different from tenant's mailing address):
City, State, Zip Code
Number and Street
Apartment Number
Instructions To Tenant:
Before filing this application, you should first notify the owner or agent in writing of all the service
decreases in this application. You should attach a copy of your letter and proof of delivery to the owner or agent . If you do not send
a letter to the owner or agent and attach a copy with proof of mailing, the owner/agent will be given additional time to respond to your
complaint.
Use this form to complain about decreased building-wide service(s) which you have not already reported to us. Mail or deliver the
original, plus one copy of the signed form, and one copy of all attachments, to the Rent Office listed on the reverse side of this form.
Keep one copy for your records.
If you want to report a decrease in services within your apartment only, please use Form RA-81. To complain about a lack of heat or hot
water, use Form HHW-1. Both forms are available at the Rent Office at Gertz Plaza or your District/Borough Rent Office.
Part I - General Information
1. The total number of apartments in this building is: ____________________ .
a.
This building is a Co-op/Condo (Complete the following):
Name of Cooperative Corp./Condo Assn.: ______________________________________________________________
Managing Agent: __________________________________________________________________________________
b.
My building is managed by a 7a Administrator:
(Name of 7a Administrator)
2. Are other tenants in this building joining in this complaint?
Yes
No If "Yes," attach the Supplemental Signature
and Affirmation, Form RA-84.1.
3. Do the tenant(s) filing this complaint have Tenant Representative(s)?
Yes
No If "Yes," you must complete the appropriate
box on each Supplemental Signature sheet.
Note: Designating a tenant as a Tenant Representative does not make that tenant a party to the proceeding. In order for a representative
who is also a building tenant to be included as a party to the proceeding, the representative's signature must appear on either the com-
plaint form or the list of supplemental signatures.
(SEE REVERSE SIDE)
RA-84 (3/14)
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