4. APPROXIMATE NUMBER OF APARTMENTS IN BUILDING:
5. YOUR COMPLAINT CONCERNS:
(
(
(
6.
)
)
)
Landlord failed to return rent security deposit.
Landlord failed to place security deposits in trust account.
Landlord failed to pay interest on security deposit.
(a) AMOUNT OF SECURITY DEPOSIT AND DATE PAID: $
(b) MOST RECENT MONTHLY RENT: $
CFB003NYC - (rev. 1/19)
1
Date:
7.
(a) DATE YOU MOVED INTO APARTMENT:
(b) DATE YOU MOVED OUT OF APARTMENT (if applicable):
(c) TERM OF FIRST LEASE:
to
8.
YOUR APARTMENT IS: (
) Rent Controlled
9.
Date you complained to the landlord:
Person contacted:
10.
(
) Rent Stabilized
By phone:
Letter:
Have there been any court proceedings regarding your rent security deposit? (
In person:
) Yes (
Other:
) No
Has there been any other litigation concerning your apartment? If so, briefly summarize the issues.
11.
If the building has changed landlords during your residence, please list them in order, starting with first. Use your recollection or
your own records (such as rent checks or receipts) to prepare the list. Feel free to add a page if more space is needed.
LANDLORD'S NAME, ADDRESS
AND TELEPHONE NUMBER
12.
PERIOD OF OWNERSHIP
FROM -- TO
MANAGING AGENT'S NAME,
ADDRESS & TELEPHONE NUMBER
Indicate the amount of interest, if any, you have received on your security deposit and the period involved.
SPACE FOR ADDITIONAL INFORMATION, ANSWERS OR COMMENTS: