INTERNAL PROTOTYPE — NOT LEGAL ADVICE — DO NOT SEND

§ 227-c

Citation
§ 227-c
Parent Document
N.Y. Real Prop. Law § 227-c
Jurisdiction
New York (state)

Full Text

744 chars
denomination.
____ Other (describe):_________________________________________________
The person who signed the Tenant/Legal Occupant Statement above has
stated to me that he/she/they, or a member of his/her/their household,
has been subject to domestic violence.
This person further stated to me the incident(s) occurred on or about
the date(s) stated above.
I understand that the person who signed the Tenant/Legal Occupant
Statement may use this document as a basis for terminating a lease with
the person's lessor.
__________________________________________
(name of qualified third party)
__________________________________________
(signature of qualified third party)
______________
(date) Acknowledgement
State of ______________________)