I am the landlord of the premises located at the following address:
________________________________________________________________________________
The tenants listed below are currently in possession of the premises (list the names of every tenant,
under-tenant, assignee, and person in possession of the premises):
1. ____________________________________ 6. ___________________________________
2. ____________________________________ 7. ___________________________________
3. ____________________________________ 8. ___________________________________
4. ____________________________________ 9. ___________________________________
5. ____________________________________ 10.___________________________________
The tenants agreed to pay $_______________ rent per month due on the _____ day of each month.
The tenant’s lease or verbal/written rental agreement ended on _______________.
The tenants were served with a written demand to vacate the premises instructing them to move out
within (check one):
30 days (tenant has occupied the unit for less than one year and does not have a lease term of at least one year)
60 days (tenant has occupied the unit for more than one year but less than two years and has a lease term of at
least one year but less than two years)
90 days (tenant has occupied the unit for more than two years or has a lease term of at least two years)
A copy of the form and proof (affidavit or affirmation) of service are attached.
If the property is located in the city of Albany, Newburgh, or Syracuse, the premises has been
registered with the city as a condition of legal rental as required by RPAPL 741 (6), (7), or (8).
A copy of Notice to Tenant of Applicability or Inapplicability of the New York State Good Cause
Eviction Law is attached.
The tenants continue to