218-220 Owners Corp218-220 East 82nd Street
New York NY 10028
APPLICANT'S RELEASE
BUILDING:APARTMENT #:
The undersigned applicant is submitting an application to sublet the above referenced apartment.
Applicant has submitted payment for certain fees including but not limited to fees to checkapplicants' credit and background check and to process this application.
Applicant acknowledges that the application to sublet the apartment may or may not be approvedby the Board of Directors of the Cooperative Corporation owning the building in its solediscretion and that if the application is not approved, no reason for the disapproval needs to begiven. Whether the application is approved or not approved certain costs and expenses will beincurred and the fees described above will not be refunded to the applicant.
The applicant releases both the cooperative corporation and the managing agent from anyliability for the return of these funds incurred in processing the application and agrees that in theevent the application seeks recovery of such fees, the applicant shall be liable for all costs andexpenses (including attorney's fees) incurred by the cooperative corporation and/or managingagent.
Applicant Date
Applicant Date
218-220 Owners Corp218-220 East 82nd Street
New York NY 10028
CREDIT/BACKGROUND CHECK AUTHORIZATION
Building: Apt. #:
Applicant Name:
Date of Birth: Social Security Number:
Home Address:
In connection with my purchase/leasing of property, I authorize the procurement of a creditreport, and if so desired a criminal background and terrorist check on myself. I furtherauthorize all credit agencies, banks, lending institutions and persons to release responsibility bydoing so. This authorization, in original or copy, shall be valid for this and any future reportsthat may be requested. Further information may be available upon written request within areasonable period of time.
Signature Date
218-220 OWNERS CORP.SUBLET APPLICATION
218-220 EAST 82ND STREETNEW YORK, NY 10028
Building: Apt. #;
Monthly Rental: S
Term of Lease: From / / to
1. SHAREHOLDER INFORMATION
Shareholder Name
Shareholder Address during Term of Sublease
Contact Information:
Home #:
Cell #:
Work #:
E-Mail:
Real Estate Company Name:
Real Estate Company Address:
Broker Name:
Work #:
Cell #:
Fax #: _
E-Mail:
. APPLICANT INFORMATION (To be completed for each applicant on Sublease)
Applicant Name:
Social Security Number:
Contact Information
Home #:
Cell #:
Work #:
E-Mail:
Applicant Current Address:
Landlord Information
Present Landlord or Managing Agent:
Landlord Address:
Current Rent/Maintenance: Length of Residency:
Previous Landlord if less than 3 Years Ago:
Your Previous Address: Length of Occupancy:
Employment Information
Employer Name:
Address:
Length of Employment:
Salary:
Job Title/Description:
Bonus/Commissions:
Schools/Colleges Attended by Applicant:
Applicant Financial Information (To be completed by each applicant. If accounts are held
jointly you do not have to duplicate Financial Information.)
A. Bank (Savings):
Address:
B. Bank (Checking):
Address:
C. Stockbroker or C.P.A.:
Address:
D. For information regarding sources of income, contact:
Applicant's Personal References
1. Name: Phone #:
Address:
2. Name: Phone #:
Address:
3. Name: Phone #:
Address:
Applicant Information, continued
Real Estate Company Name:
Real Estate Company Address:
Broker's Name:
Work #: Fax #:.
Cell #: E-Mail:
Notes:
This proposal shall result in no legal obligation until a formal lease is executed by the parties
concerned and approval is granted by the Board of Directors.
Any shareholder residing outside of New York State during the length of the Sublease period
must provide a Point of Service Designee, residing in New York State. We must have a
notarized letter from the shareholder with said party acknowledging that you have requested
them to service as such, and that they have agreed to act as a Point of Service designee and that
this Agreement is not cancelable in any way without prior written consent from the Board of
Directors.
APPLICANT SIGNATURE DATE
APPLICANT SIGNATURE DATE
FINANCIAL STATEMENT
ASSETS
Cash in Bank(s)
Money Market Accounts
Contract On Deposit
Investments: Stocks
Investments: Bonds
Investment In Own Business
Accounts and Notes Receivable
Real Estate OwnedYear and Make
Automobiles
Indicate Whether Lease or Loan
Life Insurance (Cash Surrender Value)
Retirement Funds / IRA's
Retirement Funds 401(K)
Retirement Funds KEOGH
Retirement Profit Sharing/Pension(s)
Other Assets (List on Separate Page)
TOTAL ASSETS
COMBINED ASSETS
FIRSTAPPLICANT
SECONDAPPLICANT LIABILITIES
Unpaid Income Taxes
Notes Payable To Banks
Notes Payable To Relatives
Notes Payable (Other) Attach List
Installment Accounts (Credit Cards)
Installment Accounts Automobile(s)Attach
Installment Accounts (Other) List
Mortgage(s) Payable on Real Estate
Unpaid Real Estate Taxes
Unpaid Water & Sewer TaxesHome Equity Loans on Real Estate/Line of Credit on Real EstateLoans on Life Insurance Policies(Include Premium Advances)
Credit Union Loan(s)
Medical /Health Insurance Premium(s)
Automobile Insurance Premium(s)
Other Debt(s) (List on Separate Page)
TOTAL LIABILITIES
COMBINED LIABLITIES
FIRSTAPPLICANT
SECONDAPPLICANT
COMBINED ASSETS MINUS ( - ) COMBINED LIABLITIES EQUALS : TOTAL NET WORTH $
SOURCE OF INCOME
Base Salary
Over-Time
Bonus & Commissions
Dividends & Interest Income
Real Estate Income (Net)
Social Security / Disability Income
Pension Income (401K, etc.)
Other Income (Explain)
TOTAL INCOME:
FIRSTAPPLICANT
SECONDAPPLICANT PROJECTED EXPENSES MONTHLY
Maintenance / Common Charges
Apartment Unit FinancingOther Mortgages and/orHome Equity Loans or Lines of CreditReal Estate and Water & Sewer TaxesOn Other Properties
Credit Cards
Auto Loans
Alimony and/or Child Support
Student Loans
TOTAL MONTHLY EXPENSES:
FIRSTAPPLICANT
SECONDAPPLICANT
The following is submitted as bring a true and accurate statement of the financial condition of the undersigned:
Signature: Date:
Signature: Date:
SCHEDULES A THROUGH D
A. CASH IN BANKS, MONEY MARKET, CD'S OR OTHER
NAME AND ADDRESS TYPE OF ACCOUNT CASH BALANCE
B. SECURITIES
DESCRIPTION OF SECURITY NO. OF SHARES MARKET VALUE
C. REAL ESTATE
LOCATION OF PROPERTY MARKET VALUE MORTGAGE BALANCE
D. PENSION FUNDS
DESCRIPTION AMOUNT
E. LIFE INSURANCE
BENEFICIARY / INSURANCE COMPANY AMOUNT
F. OTHER ASSETS
DESCRIPTION AMOUNT
G. OTHER LIABILITIES
DESCRIPTION AMOUNT
H. OTHER INCOME
SOURCE OF INCOME AMOUNT
WINDOW GUARD NOTICETHE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE
218-220 OWNERS CORP.218-220 EAST 82ND STREET, NEW YORK, NEW YORK 10028 APT. NO.:
NOTICE TO TENANTS OR OCCUPANT (Appendix A)
You are required by law to have window guards installed in all windows if a child 10 years of ageor younger lives in your apartment.
Your landlord is require by law to install window guards in your apartment if you ask him to installwindow guards at any time (you need not give a reason)
It is a violation of law to refuse, interfere with installation, or remove window guards whererequired.
PLEASE CHECK WHICHEVER APPLY:
Children (10) years old or younger live in my apartment
No child ten (10) years old or younger live in my apartment
I want Window Guards even though I have no children 10 Years of Age or Younger
Window Guards ARE INSTALLED in all Windows *
Window Guards ARE NOT INSTALLED in all Windows *
Window Guards NEED maintenance or repair
Window Guards DO NOT need maintenance or repair
*Except windows giving access to fire escapes or a window on the first floor that is a requiredmeans of egress from the dwelling unit.
Applicant/Tenant Name (Print) Date
Applicant/Tenant Signature Applicant/Tenant Address
Applicant/Tenant Name (Print) Date
Applicant/Tenant Signature Applicant/Tenant Address
Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards
Lead Warning StatementHousing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can posehealth hazards if not managed properly. Lead exposure is especially harmful to young children and pregnantwomen. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based paint and/orlead-based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on leadpoisoning prevention.
Lessor's Disclosure(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):
(i) Known lead-based paint and/or lead-based paint hazards are present in the housing(explain).
(ii) Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in thehousing.
(b) Records and reports available to the lessor (check (i) or (ii) below):
(i) Lessor has provided the lessee with all available records and reports pertaining tolead-based paint and/or lead-based paint hazards in the housing (list documentsbelow).
(ii) Lessor has no reports or records pertaining to lead-based paint and/or lead-basedpaint hazards in the housing.
Lessee's Acknowledgment (initial)(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Protect Your Family from Lead in Your Home.
Agents Acknowledgment (initial)(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852d and
is aware of his/her responsibility to ensure compliance.
Certification of AccuracyThe following parties have reviewed the information above and certify, to the best of their knowledge, thatthe information they have provided is true and accurate.
Lessor Date Lessor Date
Lessee Date Lessee Date
Agent Date ~ Agent Date
SMOKE / CARBON MONOXIDE DETECTOR RIDER
218-220 OWNERS CORP.218-220 EAST 82ND STREET, NEW YORK, NEW YORK 10028
I/We
have inspected apartment # at 218 / 220 EAST 82ND STREET, NEW
YORK, NEW YORK 10028
I/We have personally tested smoke/carbon monoxideNumber of Smoke / Carbon Monoxide Detectors
detectors in said apartment and have found it (them) to be in good working order.
I/We understand that the maintenance of such smoke detector(s) is my (our) responsibility.
Owner(s) Signature Date
Print Name
Applicant(s) Signature Date
Print Name
218-220 Owners Corp218-220 East 82nd Street
New York NY 10028
HOUSE RULES AND BY-LAWS ACKNOWLEDGMENT
Building: Apartmentff:
I (We) hereby acknowledge and agree to abide by the House Rules and By Laws of 218-220Owner's Corp.
Signature Date
Signature Date
218-220 Owners Corp218-220 East 82nd Streel
New York NY 10028
OCCUPANCY AND PET POLICY ACKNOWLEDGMENT
It is understood that the Unit at is to be used forresidential purposes only.
Subtenants may not harbor any pets during the term of their Sublease.
Including the applicant, the Unit will be occupied as a private dwelling by the applicant'simmediate family as follows:
Name Relationship Age
I/We understand that the Unit I am applying to sublet will be solely and exclusively used forresidential purposes.
I/We understand that as subtenants we may not harbor any pets during the term of our Sublease.
APPLICANT SIGNATURE DATE
APPLICANT SIGNATURE DATE
EMERGENCY INFORMATION FORM
APARTMENT NO.:
APT. TEL. NO.:
CELL NO.:
TENANT / SHAREHOLDER NAME(S):
MEDICAL EMERGENCY INFORMATION:
NAME(S) OF DOCTOR(S):
PREFERRED DOCTOR(S) OR HOSPITAL(S):
APT. TEL. NO.:.
CELL NO.:
MEDICALCONDITION(S)
TELEPHONE NUMBER(S):
CONTACT IN CASE OF EMERGENCY:
NAME:
ADDRESS:
TEL. NO.: (HOME):
(WORK):
ALTERNATE ADDRESS(ES):
NAME:
ADDRESS:
TEL. NO.: (HOME):
(WORK):
TELEPHONES:
EMPLOYMENT DATA:
COMPANYNAME:
ADDRESS:
TEL. NO.: (WORK):
(FAX):
TELEPHONE #:
COMPANYNAME:
ADDRESS:
TEL. NO.: (WORK):
(FAX):
EMERGENCY INFORMATION FORM - PAGE TWO
IF YOU HAVE PERMISSION TO HARBOR ANY PET(S)
TYPE BREED NAME WEIGHT AGE
LIST ANY MEDICAL CONDITION(S)
VETERANARIAN INFORMATION:
NAME:
FIRM:
ADDRESS:
TELEPHONES:
ATTORNEY TO CONTACT IN CASE OF EMERGENCY:
NAME:
FIRM:
ADDRESS:
TELEPHONES: FAX#:
DUPLICATE KEYS
DOES THE SUPERINTEDENT HAVE DUPLICATE KEYS FOR EMERGENCY ENTRANCE TO YOUR APARTMENT? YES [ ] NO [ ]
PLEASE PROVIDE DATE FOR THOSE WHO HAVE DUPLICATE KEYS:
NAME: NAME:
ADDRESS: ADDRESS:
TEL. NO.: (HOME): TEL. NO.: (HOME): .
(WORK): (WORK):
EXTRA SECURITY
DO YOU HAVE EXTRA SECURITY INSTALLED IN YOUR APARTMENT? YES [ ] NO [ ]
IF YES, PLEASE ATTACH INSTRUCTIONS THAT YOU FEEL WOULD BE HELPFUL IN AN EMERGENCY SITUATION:
PLEASE COMPLETE ALL OR PART OF THIS FORM. ALL INFORMATION WILL BE KEPT CONFIDENTIAL.
CURRENT SHAREHOLDER(S)/OWNER(S)LEGAL MAILING ADDRESS POST SUBLET
All communication concerning the ownership of Unit should be sent to thefollowing address post closing:
Owner's Name:
Address:
Home Telephone #:
Cell Telephone #:
Work Telephone #:
Home Telephone #:
Cell Telephone #:
Work Telephone #:
Owner's Signature Date
Owner's Name:
Address:
Owner's Signature Date
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