L&T Index No.: ...................................................... : Petitioner (Landlord) : -against: PETITION NON-PAYMENT Respondent (Tenant) : Address : Respondent : (Undertenant) Address : ...................................................... To: : * The undersigned, respectfully alleges that: 1. The undersigned is the** 2. Petitioner, is the owner and landlord of the premises described as follows: (hereinafter referred to as the "Premises") which Premises are situated within the territorial jurisdiction of this court; 3. Respondent Tenant"); is the tenant of the Premises (hereinafter referred to as the "Respondent 4. Respondent, is the undertenant of the Respondent Tenant; 5. On or about as said landlord and Respondent Tenant as said *** tenant entered into a rental agreement under which Respondent Tenant took possession of the Premises and promised to pay *** each month in advance on the $ day of each month for the use and occupation of the Premises; 6. Pursuant to said agreement, the foregoing rent was due to the Petitioner from the Respondent Tenant for the month(s)/period(s) of 7. Respondent Tenant has defaulted in the payments thereof and the total rent in arrears is $ 8. Said rent has been demanded personally from Respondent Tenant since the same became due; 9. Respondents hold over and continue in possession of the Premises without Petitioner's permission after said default; 2003 © American LegalNet, Inc. www.USCourtForms.com 10. (See options on attached page and insert any or all that apply) WHEREFORE, Petitioner requests a final judgment awarding Petitioner possession of the Premises together with costs and disbursements of these proceedings, and for the issuance of a warrant to remove Respondents from possession of the Premises, with interest from (insert date) and for a judgment for rent in arrears against Respondent Tenant for the sum of $ together with costs and disbursements. Dated: (Petitioner - sign above and type name below) (Attorney for Petitioner - sign above and type name below) Attorney(s) for Petitioner Office and P.O. Address Telephone No.: * Insert name of court to which petition is addressed. ** Insert "Petitioner" or "attorney for the Petitioner" or "officer of the Petitioner corporation", and type of corporation, as the case may be. *** Insert "Petitioner" or "Petitioner's Predecessor", as the case may be. 2003 © American LegalNet, Inc. www.USCourtForms.com Affidavit of Verification for Individual STATE OF NEW YORK COUNTY OF : : : ss. being duly sworn deposes and says that he/she is the (Petitioner/Attorney for the Petitioner (Petitioner is not within the county in which deponent's office is located)/agent for petitioner) in this action; that he/she has read the foregoing Petition and knows the contents thereof, that the same is true to the knowledge of the deponent except as to the matters therein stated to be alleged upon information and belief, and as to those matters he/she believes it to be true. The grounds of deponent's belief as to all matters not stated upon deponent's knowledge are as follows: Subscribed and sworn to before me this day of , 20 Notary Public Affidavit of Verification for Corporation STATE OF NEW YORK COUNTY OF : : : ss. of being duly sworn deposes and says that he/she is the Petitioner corporation named in the within action; that he/she has read the foregoing Petition and knows the contents thereof; that the same is true to the knowledge of the deponent except as to the matters therein stated to be alleged upon information and belief, and as to those matters he/she believes it to be true. This verification is made by deponent because the Petitioner herein is a Corporation, and deponent an officer thereof, to wit its The grounds of deponent's belief as to all matters not stated upon deponent's knowledge are as follows: Subscribed and sworn to before me this day of , 20 Notary Public 2003 © American LegalNet, Inc. www.USCourtForms.com OPTIONS ATTACHMENT FOR NUMBER 10 OF PETITION FOR NON-PAYMENT 10. Insert any and all of the options that apply on the attached Petition for Non-Payment: (a) The Premises are subject to rent control and the rent demanded herein does not exceed the maximum prescribed by the New York State Division of Housing and Community Renewal or any applicable regulation, guideline or order, OR; (b) The Premises are subject to the Emergency Tenant Protection Act of 1974 in that (insert reason), and the owner of the Premises has complied m all respects with the applicable provisions of said law and with all applicable regulations, guidelines and orders promulgated thereunder, OR; (c) The Premises are not subject to rent control or the Emergency Tenant Protection Act of 1974 because (insert reason). 2003 © American LegalNet, Inc. www.USCourtForms.com