Owner'S Application To Restore Rent Form (Page 2 of 2) in pdf

[ ] C.

The tenant has unreasonably refused to permit owner/agent to restore service which was the basis for a rent reduction order

or an order directing restoration of service issued _____/_____/_____, pursuant to docket number___________________.

Attach a complete copy of the order. Please explain on a separate piece of paper the circumstances and attach required

documentation as explained below:

The owner must submit copies of two letters to the tenant attempting to arrange access. Each of these letters must have

been mailed at least eight (8) days prior to the date proposed for access, and must have been mailed by certified mail,

return receipt requested. If a "no access" inspection is scheduled by this Agency, the tenant, owner and/or his repair

person(s) are required to be present and ready to begin repairs.

[ ] D.

For building-wide orders only: An affidavit of an independent licensed architect or engineer is included stating that the

conditions that are the subject of the order referenced above do not exist. The affidavit is signed by the person

investigating the condition(s) and indicates when the investigation was conducted and findings with respect to each

condition.

See Notice To Owners (RTP-19.1) for further information.

[ ] E.

FIRE/VACATE: The rent was previously reduced to $1.00 per month pursuant to docket number __________________

issued on ______/______/______. The tenant has been restored to occupancy as of ______/______/______. Please

attach evidence of this fact.

[ ] F.

A Major Capital Improvement (MCI) application has been filed for the subject building and is pending under docket number

_____________________________.

PART B - Statement and Affirmation of Owner

The owner must date and sign.

I have read the above and I affirm under the penalties provided by law that the contents are true of my own knowledge.

Date: ______/______/______ Signature of owner/agent: _________________________________________________

PART C - Owner's Certification

The owner must complete and sign, unless box C was checked above. If this building is owned by a corporation, this Certification must

be signed by a principal.

_____________________________________________, certifies that(s)he is the

(Print Name)

_____________________________________________ of __________________________________________

(Full name of owner of building, if a corporation)

(Give title: i.e., President; Individual Owner; Partner; etc)

and also certifies that the owner is fully familiar with the physical condition of the property; that the owner is maintaining and will continue

to maintain all services furnished or required to be furnished under DHCR's Rules and Regulations; and that this certification applies to all

of the apartments and all of the building-wide services in this building.

Date: _______/_______/______ Signature or owner or principal: __________________________________________________

PART D - Tenant's Statement of Consent

I, __________________________________, am the tenant of the housing accommodation involved. I have read the application and

agree that services have been restored.

Date: ______/______/______ Signature of tenant: __________________________________________________

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

DHCR, Gertz Plaza

92-31 UnionHall Street, 6th Floor

Jamaica, NY 11433

RTP-19 (5/09)

Owner'S Application To Restore Rent Form Page 2

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