Form Af-3 - Affidavit Of Compliance printable pdf download

Office of Enforcement and Neighborhood Services

Division of Code Enforcement

nyc.gov/hpd

LEAD-BASED PAINT AFFIDAVIT OF COMPLIANCE

(AF-3)

VIOLATIONS CORRECTED PRIOR TO AUGUST 1, 2004

Property owners must submit this affidavit (AF-3) with the documentation required by the affidavit for

the violations under the following conditions only if:

 You have documented proof that lead-based paint work in response to the violation was

completed prior to August 1, 2004. NOTE: If the work was completed AFTER August

1, 2004, you must use Form AF-5. (This form can only be used for violation order

numbers 555, 610, 611 AND 612).

 HPD did not observe the lead-based paint condition to exist after the date indicated on

your documentation as work completed.

Overdue LEAD-BASED PAINT HAZARD VIOLATIONS on record with the Department of Housing

Preservation and Development (HPD) can be dismissed ONLY IF

 HPD has inspected and found the work properly completed. You can check HPD’s website at

and use HPDONLINE from the home page to determine if HPD has already

inspected.

o If the violation has not already been observed corrected by, a properly completed

Dismissal Request form with the appropriate fee must also be submitted to HPD. You

can obtain a Dismissal Request form at .

 The appropriate additional documentation regarding the work methods and cleanup process is

submitted. The documentation must reflect that the work was properly completed. If you have

any questions, you may speak with the Public Interviewer at a Code Enforcement Borough

Office, call the Lead Hotline at (212) 863-6458, or visit the HPD website at NYC.gov/hpd.

To properly complete this affidavit:



The validly registered owner or agent must complete the form. (See

for

information about Property Registration.)



Indicate one or multiple violation sequence numbers for violations corrected and tested at the same

time within a single apartment.



Attach the following documents:



A copy of the State-certified laboratory analysis of all surface dust samples taken

(

provides a list of certified laboratories) which indicates the method of analysis and preparation of

the samples.



A copy of the Certificate of Training of the individual who took surface dust samples. The

Certificate of Training must be valid for the period when the test was taken.



Submit to an HPD Borough Office (see next page for addresses) with or without a Dismissal Request

form. Again, properly completed Dismissal Requests (with the appropriate fee) are required if HPD

has not already inspected the condition and found that the condition no longer exists.

Form Af-3 - Affidavit Of Compliance

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