166 166 east 78™ street new york, ny 10075 applicant's ... · new york, ny 10075...

166 TENANT'S CORP.166 EAST 78™ STREETNEW YORK, NY 10075

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

166 TENANTS CORP.166 EAST 78™ STREETNEW YORK, NY 10075

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

2. 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:

166 TENANTS CORP.SUBLET APPLICATION

166 EAST 78™ STREETNEW YORK, NY 10075

Building: Apt. #;

Monthly Rental: $

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 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


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 GUARDS REQUIREDTHE NEW YORK CITY DEPT. OF HEALTH AND MENTAL HYGIENE

NOTICE TO TENANT OR OCCUPANT (Appendix A)

You are required by law to have window guards installed in all windows if a child 10 years of age oryounger lives in your apartment.

Your landlord is required by /ow to install window guards in your apartment if:a child 10 years of age or younger lives in your apartmentORyou ask him to install window 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 where required.

PLEASE CHECK WHICHEVER APPLY:Children ten (10) years old or younger live in my apartmentNo child ten (10) years old or younger live in my apartmentI want Window Guards even though I have no children Ten (10) years of age or youngerWindow 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 required means ofegress 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 property. 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.

Agent 5 Acknowledgment (initial)

(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852d andis 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

166 TENANT'S CORP.166 EAST 78™ STREETNEW YORK, NY 10075

SMOKE/CARBON MONOXIDE DETECTOR RIDER

I/Wehave inspected apartment # at 166 East 78th Street, New York, NY 10075.

I/We have personally tested smoke/carbon monoxide detectors insaid apartment and have found it (them) to be in good working order.

I/We understand that the maintenance of such smoke and carbon monoxide detectors is my/ourresponsibility.

Owner Signature Date

Print Name

Applicant Signature Date

Print Name


HOUSE RULES AND BY-LAWS ACKNOWLEDGMENT

Building: Apartment^:

I (We) hereby acknowledge and agree to abide by the House Rules and By Laws of 166 Tenant'sCorp.

Signature Date

Signature Date

366 TENANT'S CORP.

166 EAST 78™ STREETNEW YORK, NY 10075

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.



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):

TELEPHONE #:

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:

TELEPHONE #;

ATTORNEY TO CONTACT IN CASE OF EMERGENCY:

NAME:

FIRM:

ADDRESS:

TELEPHONE*: 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. MO.: (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 #:

Owners Signature Date

Owner's Name:

Address:

Owner's Signature Date

P 1 93—S.ihlca-,; pbiinF-DgthMor © 1977 by JaliK BlombWD, Inc.. «YC 10013

SUBLEASE AGREEMENT

Date of tiu»Sublease:

Parties to this

Information fromO^er-Lease:

Tertn:

Premises rented:

Use of premises:

Rent:

Security -

Agreement to lease?ind pay rentr

Notices;

Subject to:

Qverlenant'j duties:

Co-nsen!:

Adopting theOver-Lease and

escer»t ion s:

The parties agree as follows:

Overtenant::Address for notices:

You, the Undertenant;Address for notices:

If there are more than one Overtenant or Undertenant, the words "Overtenant" and "Undertenant" used inthis Sublease includes them.

Landlord:Address for notices:

Overtenant:Address for notices:

Oatp of Over-Lease:

Term: from: to:A c^py of the Over-Lease is attached as an important part of the Sublease.

finding:years:

The premises may be used for

months: Beginning:

sgfc• - . .

only.

'!•. The yearly rent is $ - YO.U;J * i ^r i

tenant in twelve equal monthly payments of ^ .*>n the first day of each month during the Tertn.

he Undertenant, will pay this yearly rent to the Over-- Payments shall be paid in advance

5. The security for the Undertenant's p^rformrmce is $ . Overtenant states that Over-tenant has received it, Overtenant <s£{rtf hold^he security in accordance with Paragraph of theOver-Lease. \\\" , !, .--

6. Overtenanl sublets the premises to you, llie.Unyerlenaht, for the Term. Overtenant states that it has theauthority to do so. You, the Undertenant, dgree-.ip'p&y the Rent and other charges as required in the Snb-!ease. You, the Undertenant, agree to do everything required of you in the Sublease.

7. AH notices in the Sublease shall be sent by certifie^niajl, "return receipt requested".

8- The Sublease is subject to the Over-Lease. It is also subject lo any agreement to which the Over-Lease issubject. YouT the Undertenant, state that you have read and initialed the Over-Lease and will not violateit in any way.

9. The Over-Lease describes the Landlord's duties. The Overtenant is not obligated to perform the Land-lord's duties. If the Landlord fails to perform, you, the Undertenant, must send the Overtenant a notice.Upon receipt of the notice, the Overtenant shall then promptly notify the Landlord and demand that theOver-Lease agreements be carried out. The Overtenant shall continue the demands until the Landlordperforms.

10- H the Landlord's consent to the Sublease is required, this consent must be received within daysfrom the date of this Sublease. If the Landlord's consent is not received within this rime, the Sublease',yjll be void. In such event all parlies are automatically released and all payments shall he refunded toyou, the Undertenant.

11. The provisions of the Over-Lease are part of this Sublease. All the provisions of the Over-Lease applyingto the Overtenant are binding on you, the Undertenant, except these:

a) These numbered paragraphs of the Over-Lease shall not apply:

b ) These numbered paragraphs of the Over-Lease are changed as follows:

No authority:

Changes:

Signatures:

12. You. the Undertenant, have no authority to contact or make any agreement with the Landlord about thepremises or the Over-Lease, You. the Undertenant, may not pay rent or other charges to the Landlord, butonly to the Overtenan!.

13. Unless otherwise slated- the Sublease is binding on all parlies who lawfully succeed to the rights or takethe place of the Overtenanl or you, the Undertenant. Examples are an assign, heir, or a legal represen-tative such as an executor of your will or administrator of your estate.

I4-. This sublease can be changed only by an agreement in writing signed by the parties to the Sublease.

OVERTENANT:

You. ihe UNDERTENANT:

Wilr

GUARANTY OF PAYMENT WHICH IS PART OF THE SUBLEASE

Date of Guaranty:

Guarantorand address:

Reason forGuaranty:

Guaranty:

Changes snSubtense ha»ve

no effect:

WaJv

Perf o»

Waiver of jury fcr»

1. 1 know thai ihe Overtenant would! no! rent the premises to the Undertenant unless I guarantee Under-lenanf p performance. I have ,-ilso requested the Overlenanl to enter into the Sublease with the Undertenant.\e a substantial interest in making sure that the Overlenant rents the premises to the Undertenant.

7.. The following is my Guaranty:1 guaranty the full performance of the Sublease by the Undertenant. This Guaranty is absolute and with-out any condition. It includes, but is not limited to, the payment of rent and other money charges.

in addition, I agree to these other terms:3. This Guaranty will not be affected by any change in the Sublease, whatsoever. This includes, but is not

limited to, any ex tent km of time or renewals. The Guaranty will be binding even if I am not a party tothese changes,

4. I do not have to be informed about any failure of performance by Undertenant. I waive notice of non-payment or nonperformance.

5. If the Undertenant fails to perform under the Sublease, the Overtenarit may require me to perform with-out first demanding that the Undertenant perform.

6. ! give up my right to trial by jury in any claim related to the Sublease or this Guaranty.

7. This Guaranty of payment and performance can be changed only by written agreement signed by allparties to the Sublease and Guaranty.

GUARANTOR:

WITNESS:

EPA and HUD Lead Paint Regulations, Effective September 6,1996'

Landlords must disclose known lead-based paint and lead-based paint hazards of pre-1978 housing to tenants.1 Use the followingBLUMBERG LAW PRODUCTS (800 LAW MART) to comply:

3140 Lead Paint Information Booklet 3141 Lead Paint Lease Disclosure Form'December 6, 1996 for owner':; of 1 to 4 residential dwellings-leases for less than 100 dayr. 0-bcdroom units, elderly and handicapped housing (unless children live there) and housing found to he lead-free by a certifiedinspector arc excluded.

166 166 east 78™ street new york, ny 10075 applicant's ... · new york, ny 10075...

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