Application For A Rent Reduction (Page 2 of 2) in pdf

Application For A Rent Reduction Page 2

4. If tenants are represented by an attorney, please complete the information below.

(Attorney's Name)

(Address)

(City, State, Zip Code)

(Telephone Number)

5. The conditions noted in this application were brought to the attention of the owner or agent by letter on _____/_____/_____

(Date )

The letter was (check one):

sent by regular mail;

sent by certified mail;

personally delivered. A copy of the letter and

proof of mailing is attached to this application.

Important: You must submit proof of mailing or delivery (e.g. certificate of mailing, certified mail receipt, or signed receipt from

owner/agent acknowledging personal delivery).

Part II - Description Of Decreased Service(s)

Describe in detail

Check the box next to the area where the condition (equipment or decreased service) exists.

(a) the condition which exists, or the equipment or service which is not being maintained, and

(b) the specific area in the building where the condition exists.

Example:

Staircase: The hand rail is missing between the 3rd and 4th floors, and the 7th floor fire door does not close.

Please be very specific in order to ensure the timely processing of your application.

Important:

If you are complaining about decreases in any of the following services, you must also complete and attach

Form RA-84.2: laundry, doorman, security, storage and/or playgrounds.

The owner has failed to provide or maintain the following building-wide services:

Entrance:

Lobby:

Hall:

Staircase:

Elevator:

Other:

Part III - Tenant's Affirmation

I have read the information on this form, and I affirm the contents to be true to my own knowledge.

Tenant's Signature

Date

False statements may subject you to penalties provided by law.

Mail or deliver this form to the DHCR office listed below.

DHCR, Gertz Plaza

92-31 Union Hall St., 6th Floor

Jamaica, NY 11433

RA-84 (3/14)

Application For A Rent Reduction Page 2