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218-220 Owners Corp 218-220 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 check applicants' credit and background check and to process this application. Applicant acknowledges that the application to sublet the apartment may or may not be approved by the Board of Directors of the Cooperative Corporation owning the building in its sole discretion and that if the application is not approved, no reason for the disapproval needs to be given. Whether the application is approved or not approved certain costs and expenses will be incurred and the fees described above will not be refunded to the applicant. The applicant releases both the cooperative corporation and the managing agent from any liability for the return of these funds incurred in processing the application and agrees that in the event the application seeks recovery of such fees, the applicant shall be liable for all costs and expenses (including attorney's fees) incurred by the cooperative corporation and/or managing agent. Applicant Date Applicant Date

218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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Page 1: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 2: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 3: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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:

Page 4: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

. 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:

Page 5: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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:

Page 6: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 7: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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:

Page 8: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 9: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

E. LIFE INSURANCE

BENEFICIARY / INSURANCE COMPANY AMOUNT

F. OTHER ASSETS

DESCRIPTION AMOUNT

G. OTHER LIABILITIES

DESCRIPTION AMOUNT

H. OTHER INCOME

SOURCE OF INCOME AMOUNT

Page 10: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 11: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 12: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 13: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 14: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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

Page 15: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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):

Page 16: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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.

Page 17: 218-220 East 82nd Street New York NY 10028 APPLICANT'S RELEASE APARTMENT · 2019-12-02 · New York NY 10028 APPLICANT'S RELEASE BUILDING: APARTMENT #: The undersigned applicant is

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