NYCHA MANAGEMENT MANUAL – CHAPTER IV

TERMINATION OF TENANCY

APPENDIX A

I. INSTRUCTIONS FOR PREPARATION OF FORMS IN HOLDOVER

PROCEEDINGS

Petition and Notice of Petition – Copies Needed

1 Original Copy – Court
2 Copies with Original Signature – Project Folder
1 Copy for Legal Department

Copies For Each Tenant/Signatory to the Lease:

Personal Service – 1 Copy
Substituted or conspicuous Service – 3 Copies (one on or under door, one
mailed regular first class mail, and one mailed certified).

Dispossess or Eviction Proceeding – Postcard – 1 copy.

A. Original Notice of Petition-Holdover, NYCHA Form 040.082A&R and Copy Notice of

Petition-Holdover, NYCHA 040.082B-R.

Prepare the Original and copies putting the necessary information in the spaces
corresponding to the boxes in “Exhibit A”:

Box 1: Insert project in upper right hand corner.

Box 2: Insert County in which Processing is brought in blank space above caption.

Box 3: In caption, above and to the left of “Respondent(s), Tenant(s)” insert full
names and addresses of all persons who signed the lease and are currently
tenants.

Box 4: Insert on the second line of the paragraph beginning PLEASE TAKE
NOTICE, the County in which the Court is located, the address of the Court,
the Borough, the day, month and year of Court hearing. The day inserted
must be the day designated as Court Day for your project. It must be no less
than five (5) days and no more than twelve (12) days from the day on which
service is to be made.

Example: Project assigned Friday as Court Day. Service of Notice of

Petition and Petition expected about November 17, 1983.
Earliest day that could be inserted in the Notice of Petition
would be November 22, 1983. However, November 22, 1983 is
not a Court Day so the day to be inserted is November 25,
1983, a Court Day more than five (5) days and less than twelve
(12) days from date service is to be made.

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APPENDIX A

Box 5: On the line beginning “Authority verified” insert the date the petition was
sworn to before the Notary Public and in the following lines insert after the
“possession of premises described as follows” the apartment No., floor, room
size, address of the building in which apartment is located and County in
which property is located.

Box 6: On the line beginning with “TAKE NOTICE” fill in the total rent arrears. The
words “interest from” should be followed by the first day of the first month this
amount is due.

Box 7: Insert the County in which the Proceeding is being brought on the line
beginning “Dated: City of New York, County of…”

Box 8: The Clerk of the Court signs form on the bottom and inserts the day, month,
and year and provides the index number.

Note: Project must conform all copies with the original, as regards date, print
in name of Court Clerk and L&T number.

B. Original Petition – Summary Proceedings – Holdover, NYCHA Form 040.082&R, and

Copy Petition – Summary Proceedings – Holdover, NYCHA Form 040.082B&R.

Prepare the original and copies as follows, putting the necessary information in the
spaces corresponding to the boxes in Exhibit B:

Box 1: Insert project in upper right-hand corner.

Box 2: Insert on first line, the name of the County in which the Proceeding is being
brought.

Box 3: Insert in paragraph 2, the names of tenants currently in occupancy who

signed the lease.

Box 4: Insert, on the lines immediately following, the number of rooms, the floor
number, the apartment number of the particular apartment involved, the street
address of the apartment and the County in which the premises are located.

Box 5: Insert on the following lines after the words “for the term of one (1) month
commencing on the 1st day of” and after the words “and terminating at
midnight on the last day of” the month in which the most recent lease was
signed. The month to be inserted is found in the Resident Monthly Lease
Agreement (040.001 and 040.001F) on the line which reads “beginning the
first day of , 19 , and terminating at midnight on the last of
, 19 .”

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APPENDIX A

Box 6: Insert the date the Authority members made a determination to terminate the
tenancy of tenants.

Note: A copy of the 30 Day Notice to Vacate and the original of the Affidavit
of Service of the 30 Day Notice to Vacate must be attached to the
original petition for the Court. These papers must also be attached to
the copies served on the tenant. All copies must have original
signatures. Carbon copies or photo static copies of signatures are not
acceptable.

Box 7: In the sentence beginning “WHEREFORE” insert the total rent arrears.
Insert the monthly rent on the indicated line. “Interest from” should be
followed by the first day of the first month the arrears are due.

Box 8: Insert the date the Petition is signed, following the works “Dated: New York”
(which appears just under the WHEREFORE paragraph).

Box 9: The Housing Manager must sign on the line over the word “Manager”. Only in
the Manager’s absence, may either the assistant Manager or the
Superintendent sign as “Acting Manager”.

Box 10: The affidavit form on the bottom of the page (below the line signed by the
Housing Manager) is known as the “Verification”. In it must be inserted the
County in which the notary signs the forms and the name of the Manager. The
word “acting” is inserted in the blank space if the verification is not signed by
the Manager.

Box 11: The “Verification” must also be signed by the Manager with his signature
notarized.

Box 12: The notarization is accomplished by the insertion of the day, month and year
and the signature and the stamp of the notary, in the appropriate, places in the
lower left-hand corner of the form.

II. INSTRUCTIONS FOR PREPARATION OF FORMS IN NON-PAYMENT

PROCEEDINGS
A. Original Notice of Petition-Summary Proceeding (Dwelling), NYCHA Form 040.083B&R.

Prepare original and copies, putting the necessary information in the spaces corresponding
to the boxes in Exhibit C:

Box 1: Insert project name.

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APPENDIX A

Box 2: In caption, to the left of “Respondent(s) Tenant(s) and Address”, insert the full
name or names and address of all persons who have signed the most recent
lease and who are in occupancy.

Box 3: Insert on the line starting with “Please take notice” and on the next line, the date
on which the petition is signed and notarized.

Box 4: Insert, on the lines immediately following, the apartment number, the floor, the
number or rooms, and the street address of the tenant’s apartment.

Box 5: Insert, in the first TAKE NOTICE paragraph, the total amount due for rent.
(Additional charges may be included in State and City projects only.)

NOTE: The amount for rent to be inserted in Box #5 of Exhibit C is the same
amount as the amount to be inserted in Boxes #12 and #15 of Exhibit D.

Box 6: Insert, on the following line, the first day of the latest month for which rent
became due.

Box 7: The Court clerk fills in the date and the signature in spaces which occur at the
bottom of the form and provides the index number.

B. Form 040.083&R (State & City), 040.083F&R (Federal) Original Petition-Non-Payment of

Rent Dwelling.

Prepare originals and copies, putting the necessary information in the spaces
corresponding to the boxes in Exhibit D (Federal) & Exhibit E (State & City):

Box 1: Insert project name in upper right-hand corner.

Box 2: Insert the Name(s) of the tenant(s), i.e., the person(s) who signed the most
recent lease with the Authority and are in occupancy.

Box 3: Insert, on the next line (immediately following the words “amended effective the
first day of”), the month and year on which the latest rent change became
effective. For example, the Lease Amendment portion of an RCA served on the
tenant on September 30, 1982, notified him that effective November 1, 1982,
his/her rent would be increased. The month to be inserted in the space following
the words “amended effective the first day of” is November.

Box 4: Insert in the following lines, after the words “designated as follows”, the number
of rooms, the floor number, the apartment number of the particular apartment
involved and the street address of the apartment.

Box 5: Insert, after the words “commencing on the 1st day of” the month and year on
which the most recent change became effective (see item “3” immediately

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APPENDIX A

above). Insert after the words “on the last day of,” the month and year on which
the most recent rent change became effective (see item “3” immediately
above). Insert after the words “on the last day of,” the month and year on which
the most recent rent change became effective

Box 6: Insert the amount of rent per month which the tenant(s) agreed to pay per month.

Box 7: Insert, the last month and the year for which rent is claimed in the Petition.

Box 8: Insert the total amount the tenant owes for regular monthly rent.

Box 9: Insert, after the words “described; to wit, from the first day of” the earliest month
and the year for which rent is claimed.

Box 10: Insert after the words “the last day of”, the current month and year for which rent
is claimed. For example: if the rent claimed is for December and January,
January is to be inserted.

Box 11: Insert the retroactive rent surcharges or any other charges in this space.
Include only regular retroactive rent.

See Exhibit D for example of tenant with retroactive surcharges.

See Exhibit E for example of tenant owing one month’s rent and additional
service charges. State and City Aided Projects Only.

Box 12: Insert total amount for rent and charges owed. (See note on Page 7, Box #5.)

Box 13: In space following this box, type in explanation of charges. If there is no room in
the space to type an explanation, insert “see rider”. For examples see Exhibits D
& E.

Box 14: If payment of rent has been requested personally of the tenant strike out
everything in the paragraph after the words “default in the payment thereof”, in
the second line. Exhibit E is an example of a personal demand for rent. In the
same paragraph, if payment of rent had been requested by way of service of
written Three-Day Notice, strike out the first two lines of the paragraph through
the words “default in the payment thereof”. Insert, in the paragraph, the day,
month and year on which the Three-Day Notice was served (a copy of the Three
– Day Notice and the original of the Affidavit of Service must be attached to the
original petition for the Court. Exhibit D is an example of a written request for
rent.

Box 14a: In paragraph 10 Exhibit D – (Federal Projects only), insert the day, month and
year on which the tenant(s) 14-Day Notice to Caveat was served.

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APPENDIX A

Federal Projects’ Sequence of Service:

1. Serve 14 – Day Notice by ordinary mail or slip under apartment door.

2. After expiration of 14 days, make personal demand for rent or serve Three-
Day Notice. (Three-Day Notice to be served by personal, substitute or
conspicuous place service and Affidavit of Service prepared).

3. Serve Petition and Notice of Petition. (If written Three-Day Notice was
served, wait until 3 days have expired).

Box 15: Insert in the WHEREFORE Clause, after the words “for the sum of” the total
amount of the arrears. (See note on page 7, Box 5.)

Box 16: Insert in the WHEREFORE Clause, after the words “Dated: New York,” the date
on which the Petition is signed.

Box 17: Have affixed the signature of the Housing Manager or his/her representative
above the word “Manager”. Only in the Manager’s absence may the
Superintendent or the Assistant Manager sign as “Acting Manager”.

Box 18: The Manager’s name is typed on the line to the left of “being duly sworn….”. The
word “acting” is inserted in the blank space, if it is signed in the Manager’s
absence.

Box 19: The affidavit form on the bottom of the page (below the line signed by the
Housing Manager) is known as the “Verification”. It must also be signed by the
Manager on the bottom of the page with his/her signature notarized.

Box 20: The notarization is accomplished by the insertion of the day, month, and year,
and the signature and stamp of the notary in the appropriate places in the lower
left hand corner of the form.

EXHIBIT D-RIDER
RIDER TO PETITION – NON-PAYMENT OF RENT

$25.00 – Additional sum chargeable as current rent arising from change in income.

EXHIBIT E – RIDER

RIDER TO PETITION – NON-PAYMENT OF RENT

$25.00 – $15.00 for cylinder charge

$10.00 toilet stoppage

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APPENDIX A

III. INSTRUCTIONS FOR COMPLETION OF AFFIDAVIT OF INVESTIGATOR –

NYCHA FORM 040.085A & REQUEST FOR FINAL ORDER AND ISSUANCE
OF WARRANT – NYCHA FORM # 150.106&R AND POSTCARD NYCHA FORM
# 150.105.
A. AFFIDAVIT OF INVESTIGATOR – EXHIBIT F :

Box 1: Insert county in which the proceeding has been brought.

Box 2: Insert the L & T number. After all other essential information is entered (as
described in Boxes 1-11,) the Affidavit of Investigator is mailed to the Marshal
(form must be filed in Court within 20 days after the tenant is interviewed
concerning military dependency.)

Box 3: Insert name of project.

Box 4: Insert full name or names of all persons who signed the lease and are currently
tenants.

Box 5: Same as Box 1 above.

Box 6: Insert full name of interviewer (no initials are allowed).

Box 7: Insert full home or business address of interviewer.

Box 8: Insert on the following two lines the room size, floor, apartment number and full
mailing address of the tenant.

Box 9: Insert on the following lines the date, full mailing address and name of person
interviewed or alternatively, see Exhibit F where the affidavit is based on a
conversation with the Manager instead of the tenant. (See Section V,B,4 of
Chapter IV). In this case the full name of the Project Manager as well as the
name and address of the tenant must be inserted.

Box 10: The Interviewer must sign by writing full first name and last name (initials are not
allowed) in this space.

Box 11: After the affidavit has been signed the Notary or Commissioner of Deeds must
sign and stamp the affidavit and insert the date of swearing. This date may be
the same as or later than the date in Box #9. It may not be earlier.

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APPENDIX A

B. REQUEST FOR FINAL ORDER AND ISSUANCE OF WARRANT – NYCHA FORM

150.106&R – EXHIBIT G:

Box 1: Insert county in which the proceeding has been brought

Box 2: Insert Housing Part

Box 3: Insert L & T number

Box 4: Insert name of project

Box 5: Insert full name(s)s of all persons who signed the lease and are currently
tenants, including the full address and apartment number (do not use account
numbers).

Box 6: Manager signs his/her name

C. POSTCARD – NYCHA FORM 150.105 – EXHIBIT G1

Box 1: Insert full name(s) of each tenant (all persons who signed the lease) or
respondent and project address, including apartment number and zip code. Use
one postcard for each respondent or tenant.

Box 2: Place correct-amount stamp on card (presently $0.19)

Box 3: Place an X in the box that reflects the action; either Non-payment or Holdover
Proceeding –

For a Holdover Proceeding

Fill in the Court return date and L & T number. Return the postcard to the
court after service of the Petition and Notice of Petition when filing the
Petition’s Affidavit of Service with the clerk.

For a Non-Payment Proceeding

Send the filled-in postcard to the Marshal along with the Petition and Notice of
Petition.

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APPENDIX A

IV. INSTRUCTIONS FOR PREPARATION OF FORMS IN HOLDOVER LICENSEE –

SQUATTER PROCEEDINGS.
A. Original notice of Petition – Holdover Licensee – Squatter, NYCHA Form 040.319&R.

“EXHIBIT H”

Refer to instructions for the preparation of Forms in Holdover Proceedings. Pages 1 and 2 of
the Appendix.

NOTE: All forms in this proceeding should be addressed to the occupant(s) known by
Project Management to reside in the subject premises. If, in addition to the
known Licensee, the name(s) of any other occupant(s) are unknown, add “and
John Doe and Jane Doe”. Service of appropriate papers must be made on each
person known or unknown.

The word “Squatter” must be crossed out wherever it appears on the form for a
Holdover – Licensee Proceeding.

B. Petition – Holdover – Licensee, NYCHA Form 040.317&R

“Exhibit I”

This form must be prepared to conform with “Holdover – Licensee – Ten Day Notice to
Quit” NYCHA Form 040.320 and “Affidavit of Service” NYCHA Form 040.318.

NOTE: A copy of the Ten Day Notice to Quit and the original of the Affidavit of Service of
the Ten day Notice to Quit must be attached to the original petition for the Court.
These papers must also be attached to the copies served on the tenant. All
copies must have original signatures. Carbon copies or photostatic copies of
signatures are not acceptable.