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Application For Certification Of No Harassment Form. This is a New York form and can be use in New York Local County.
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Tags: Application For Certification Of No Harassment, New York Local County, New York
MATHEW M. WAMBUA
Commissioner
VITO MUSTACIUOLO
Deputy Commissioner
DEBORAH RAND
Assistant Commissioner
Office of Enforcement and Neighborhood Services
Housing Litigation Division
100 Gold Street
New York, N.Y. 10038
nyc.gov/hpd
Applicant:
Enclosed is an application for a Certification of No Harassment or Exemption. Answer all questions
Yes, No or None.
The application must be typed or printed and submitted, with one copy, to the Department of Housing
Preservation and Development according to the filing instructions. Please submit your application to the
Housing Litigation Division, Certification of No Harassment Unit, 100 Gold Street, Room 6P6, New York City,
NY 10038. Attention: Rhonda Waldon
Please be certain to submit the fee along with the completed application so that your application will be
accepted. Attach original certified copies of all deeds in existence during the thirty-six month inquiry period, a
copy of the your permit application to the Department of Buildings, if one was submitted, and an original
certified copy of the Certificate of Occupancy, if one exists. If there is no Certificate of Occupancy, please
attach an Original Certified Letter from the Department of Buildings stating that the building does not have a
Certificate of Occupancy. Unless your application is fully completed and the requested documentation
attached, it will not be processed. The Department, at its discretion, may require a copy of the architectural
plans.
You have an ongoing responsibility to update your application during the pendency of the application
process. Any material misstatement or omission in the initial application or required updates may result in the
denial of the certification of no harassment. If your application is denied, you must wait three years before you
will be allowed to file a new application for a certification of no harassment.
You are expected to cooperate fully with the Department in its investigation of this application, and to
provide access to the subject premises to the Department’s employees. We reserve the right to reject your
application if we do not receive your full cooperation.
If you have any questions about the application process, you may call the Certification of No
Harassment Unit at (212) 863-8266.
MS. WALDON IS AVAILABLE TO ACCEPT WALK-INS
(PEOPLE WITH QUESTIONS OR THOSE WISHING TO PICK UP OR
DROP OFF AN APPLICATION) BETWEEN THE HOURS OF
9 AM – 11 AM ONLY
Rev. 8/12
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MATHEW M. WAMBUA
Commissioner
VITO MUSTACIUOLO
Deputy Commissioner
DEBORAH RAND
Assistant Commissioner
nyc.gov/hpd
Office of Enforcement and Neighborhood Services
Housing Litigation Division
100 Gold Street
New York, N.Y. 10038
INSTRUCTIONS
DETERMING WHETHER TO APPLY FOR A CERTIFICATION OF
NO HARRASSMENT OR EXEMPTION
This is an application for a Certification of No Harassment or an Exemption from the requirement of obtaining a
Certification of No Harassment. Be sure to check the appropriate box in the application under #1. If you are applying for
an Exemption, indicate the letter designation of the Exemption you are seeking in #2. The term single room occupancy
multiple dwelling shall not include:
a)
College or School Dormitory;
b)
Clubhouse. Submit documentation from the Department of Buildings classifying the building as a
clubhouse;
c)
Luxury Hotel. This is defined as a single room occupancy multiple dwelling in which the rent on May 5,
1983, exclusive of governmentally assisted rental payment charged for seventy-five percent or more of
the total number of occupied individual dwelling units was more than fifty-five dollars ($55.00) per day
for each unit rented on a daily basis, or more than two hundred and fifty dollars ($250.00) per week for
each unit rented on a weekly basis or more than eight hundred and fifty dollars ($850.00) per month for
each unit rented on a monthly basis;
d)
Residence whose occupancy is restricted to an institutional use such as housing intended for use primarily
or exclusively by the employees of a single company or institution;
e)
City-owned multiple dwelling;
f)
Any multiple dwelling containing fewer than nine class B dwelling units used for single room occupancy
unless the total number of such units is more than fifty percent of the total dwelling units in such multiple
dwelling. For example, a building containing eight single rooms and eight apartments would qualify, but
one containing eight single rooms and fewer than eight apartments would not qualify; and
g)
Any class A or B multiple dwelling which is (a) the subject of a program approved by the
Commissioner of Housing Preservation and Development and related to the rehabilitation and
preservation of single room occupancy multiple dwellings other than a program of tax abatement or tax
exemption, including, but not limited to programs of tax abatement or tax exemption authorized by
subchapter two of chapter two of title eleven of the Administrative Code or section four hundred twentyone (a) of the real property tax law, and (b) exempted from the provisions of this section by such
Commissioner.
If an exemption is claimed you must attach a cover letter detailing the basis for the exemption and all
documentation substantiating such claim. Please note, that if you claim an exemption you are not
required to complete the entire application. You are required to complete only questions 1, 2, 4, 5, 6, 7, 8
and 9.
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HOW TO FILE YOUR APPLICATION AND FEE REQUIREMENT
An original and one copy of this application together with accompanying documents, should be filed with
the Department of Housing Preservation and Development, Operations Division, Anti-Harassment Unit, 100 Gold
Street, 6th floor Room 6P6, New York, NY 10038, by mail or in person between the hours of 9 am to 11 am
only. This application must be filed along with a fee in the form of a check or money order payable to the
Department of Housing Preservation and Development of the City of New York.
a)
b)
c)
d)
On buildings of 10 units or less - $500.
On buildings of 11 units to 30 units inclusive - $1,500.
On buildings of 31 units to 50 units inclusive - $2,500.
On buildings of more than 50 units - $3,500.
WHO MAY APPLY
Only the owner (as shown on the deed) or his agent or a contract vendee in possession may apply for a
certification or exemption. If you are a contract vendee you must submit a copy of the contract to purchase the
building and a copy of the insurance policy for the building.
The applicant must be an individual. If the owner or contract vendee in possession is not an individual
but a partnership or corporation, a general partner or corporate officer are considered applicants for their
respective business entities, and must complete the application and sign accordingly. In the case of a cooperative,
the certification must be applied for by an authorized officer of the cooperative corporation and will be issued to
the cooperative corporation. In the case of a condominium, it must be applied for by the condominium
association or homeowner’s association and will be issued to that association.
INQUIRY PERIOD
The inquiry period begins thirty-six month prior to the acceptance of your application by the Department
or, if an Alteration or Demolition application was made to the Department of Buildings, thirty-six months prior to
the date that application was made and ends when a final determination is made by the department. It is during
this time period that the Department must find evidence of harassment to trigger an administrative hearing.
(Please read the attached copy of Local Law 19 which details the procedures used by the department in enforcing
this statute).
NEW OWNERS OR CONTRACT VENDEE IN POSSESSION
Even though you may have only recently purchased or took possession of the building you are still
responsible for providing the information necessary to complete the application for the entire inquiry period. A
finding of harassment may be based on conduct of a prior owner as long as the Department finds that such
harassment occurred during the thirty-six month inquiry period.
ONGOING DUTY TO UPDATE YOUR APPLICATION AND COOPERATE
You have an ongoing obligation to update the information on your application and to cooperate with the
Department’s investigation of your application. Failure to cooperate or provide additional information or updates
may result in the rejection of your application. You should also be aware that false or misleading statements or
material omissions in the application may subject you to denial of the certification.
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APPLICATION FOR CERTIFICATION OF NO HARASSMENT OR EXEMPTION
1.
Check (a) or (b)
I am applying for:
2.
(a)Certification of No Harassment
(b)Exemption
If you are applying for an exemption, please indicate the letter designation for the exemption you are
seeking. (See instructions.)
_______________
INQUIRY PERIOD WILL BE ESTABLISHED BY HPD
3.
INQUIRY PERIOD
/
month
4.
/
day
to
year
/
month
/
day
year
Premises for which certification or exemption sought. (subject premises)
_____________________________________________________________________________
house number
street
borough
Zip Code
block _________
lot _________
Building name by which the subject premises is known:_________________________________
5.
______________________________________________________________________________
Name and mailing address of Applicant. ( Must be an individual, please see instructions).
___________________________________________________________
name
______________________________________________________________________________
house number
street
city/state
Zip Code
Telephone:
Business: (
Home:
(
)
)
Email Address:______________________________
6.
Relationship of applicant to subject premises (for example: owner, contract vendee in possession, officer of
owner) _____________________________________________________________
7.
Name(s) of deed owner(s) __________________________________________________
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Remember to submit an original certified copy of all recorded deed(s) to cover the inquiry period. You
can obtain a certified copy from the City Register in the borough where the premises are located.
8.
Please describe the subject premises. In 8(a) describe the actual appearance of the premises. In 8(b)
describe the legal configuration of the units in the premises, if different.
a.
Actual appearance of premises:
SRO Units
Residential Units
b.
vacant
occupied
Commercial Units
Non SRO Units
vacant
occupied
If different, describe the legal configuration of the units in the premises. Remember to include a
certified copy of the Certificate of Occupancy for the building, if one exists. If there is no
Certificate of Occupancy, please obtain a letter from the Department of Buildings that the
building does not have a Certification of Occupancy.
SRO Units
Residential Units
Commercial Units
Non SRO Units
vacant
occupied
vacant
occupied
9.
For what purpose are you applying for a certification of no harassment or exemption? Briefly describe
the work you intend to do at the premises. Copies of plans may be requested.
10.
Have you ever applied for a certification of no harassment before? If so, indicate the building(s) for
which the certification of no harassment was sought and the disposition of the application(s).
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11.
Please provide the requested information for the applicant and any other individuals who exercises
any discretion in the management of the premises or was involved in the operation of the building
during the inquiry period, e.g. managing agents, on site managers, superintendents, caretakers, rent
collectors, former owners, etc.
Name, Address and
Relationship
to the premises
Birthdate
and
Social Security #
Person or
Entity By
Whom Employed
Dates During Which
Services Were Performed
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12.
Complete this item if the owner of the premises is a corporation, LLC or a partnership. If the owner is
one of the entities, in addition to the information provided in the columns below please submit an
Opinion of Counsel letter which authorizes the individual to file the application. An opinion of counsel
letter is a letter by an attorney that the person signing on behalf of the applicant, corporation, partnership
or limited liability corporation, is entitled to file and act on behalf of the entity and to make all of the
representations and commitments therein.
Name
Relationship to owner
Residence and
Business Address
Business and
Home Phone
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13.
List the names of all owners who held their interest during the Inquiry Period. For each owner, provide
address and phone number, if known, and indicate the period of ownership.
14.
Has the premises been managed or operated by an entity other than the owner during the Inquiry Period?
(For example, net lessee, mortgagee in possession, receiver, etc.) If so, provide name, address, phone
number and description of relationship to the premises for each such entity. Be certain to indicate the
time period during which the premises were operated by the entity in question.
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15.
List all criminal convictions of person or entities listed above in items 11, 12, 13, and 14 which occurred
during the inquiry period, as well as all currently pending criminal proceedings in which such persons
are defendants. Note that requests for additional information and documentation may be made in the
future.
Name
Court where
proceeding pending
or conviction
Case
or
Docket No.
Name
of
Complainant(s)
Disposition
or
Current Status
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16.
List all proceedings before the Division of Housing and Community Renewal (DHCR) involving the
subject premises which were commenced, pending or resolved after the opening date of the inquiry
period to and including the date of filing this application. Note that requests for additional information
and documentation may be made in the future.
Name
Case
or
Docket No.
Nature
of
Proceedings
Attorneys
for
parties, if any
Disposition
or
Current Status
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17.
List all current residential and commercial occupants of the subject premises and provide requested
information as to each. If there are any changes in the information provided here during the pendency of
this application please inform us immediately in writing.
Name
Date occupant
began living at
the premises
Room,
Apartment or
Commercial Unit
Telephone No.
of
Occupant
Amount of
Monthly
Rent
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18.
List all former occupants who have surrendered the units they occupied at the subject premises, or
otherwise vacated, from the opening date of the inquiry period to the present. If you have not owned the
premises during the entire inquiry period, please contact former owners for this information.
Name
Unit
Occupied
Date
Vacated
Reason for Vacating
(e.g. Court Action)
Current Address
and Phone No. of
Former Occupant
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19.
List all lawsuits relating to the subject premises commenced, pending or resolved during the inquiry
period. Note that requests for additional information and documentation may be made in the future.
Title
of
Action
Index No.
and
Court
Attorney(s) for
Plaintiff(s)
(Name, Address,
and Phone No.)
Attorney(s) for
Defendants(s)
(Name, Address,
and Phone No.)
Nature
of
Action
Disposition
or
Current Status
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Please answer questions 20, 21, and 22 below in good faith, to the best of your ability. If you do not have
sufficient personal knowledge to answer these questions, or any other questions on this application, please
endeavor to obtain the required information by contacting former owners, tenants, government agencies, etc.
20.
a)
b)
21.
a)
b)
22.
a)
b)
Has any owner of the premises, its agents, employees or other persons acting on its behalf used
force, or threatened the use of force against the person or property of any occupant of the
premises during the inquiry period?
Yes
No
If the answer to “a” is yes, give details
Have there been any interruptions or discontinuations of services at the premises during the
Inquiry Period, including, but not limited to: heat, hot water, cold water, electricity, gas and/or
elevator service?
Yes
No
If the answer to “a” is yes, give details
Has any owner of the premises, its agents, employees or other person acting on its behalf
removed the possessions of any occupant from the dwelling unit; removed, plugged or
otherwise rendered the lock on an entrance door inoperable or changed the lock on an
entrance door without supplying the occupant with a key?
Yes
No
If the answer to “a” is yes, give details
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I have read the within application and believe its entire contents to be true and complete.
The owner of the property hereby consents to access by the Department of Housing Preservation and
Development to the premises which are the subject of this Application, at all times and without prior notice, for
the purpose of investigating all facts relevant to this Application, from the date hereof until the date upon which
the Department of Housing Preservation and Development makes a final determination with respect to the grant
or denial of the Certification of No Harassment pursuant to this Application.
It is understood that failure to provide such access when requested will prevent the processing of this
application and may, in the discretion of the Department, cause denial of the issuance of a Certification.
Further, it is understood that if this application contains any false or misleading statements, or material
omissions the application may be denied.
Further, it is understood that the applicant and/or undersigned must obtain a Certification of No
Harassment from the Department of Housing Preservation and Development and all necessary permits
from the Department of Buildings prior to commencing the work at the subject premises which is the
subject of this Application.
___________________________________
Applicant's Signature
_________________________________________
Applicant's Signature
___________________________________ _________________________________________
Print Name Above
Print Name Above
__________________________________
Relationship to Property
_________________________________________
Relationship to the Property
__________________________________
Individual Fee Owner's Signature
__________________________________________
Individual Fee Owner's Signature
_________________________________ ___________________________________________
Print Name Above
Print Name Above
____________________________________
Corporate Fee Owner's Signature
____________________________________
Print Name and Title Above
Sworn to this _______ day of _________________,
200__.
____________________________________________
NOTARY
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