Civil Court of the City of New York County of Index Number Housing Part AFFIDAVIT IN SUPPORT OF AN ORDER TO SHOW CAUSE To Restore to the Calendar for a Compliance Hearing and for Assessment of Civil Penalties (H.P.) Petitioner, -against- Address: Respondent(s), and The Dept. of Housing Preservation and Development State of New York, County of (Address of Petitioner) Apt.# ss: I 1. PARTY: being duly sworn, deposes and says: I am the in the above proceeding. (Petitioner/a [relative/friend/etc.] of the Petitioner) 2. HISTORY: An Order of the Court directing the correction of violations was made, or a stipulation between the parties was entered into, on 3. FACTS: The following violations / conditions have not been corrected: 1) 4) 7) 2) 5) 8) 3) 6) 9) TENANT'S INITIALS 4. PRIOR ORDER I have not requested a prior Order to Show Cause for a Compliance Hearing in this case. I have requested a prior Order to Show Cause for a Compliance Hearing in this case but I am making this further application because 5. REQUESTS: I respectfully request that: - this case be restored to the calendar for a Compliance Hearing and assessment of civil penalties (fine) against my landlord since violations have not been corrected pursuant to the Court's Order. - because I am appearing in person, without an attorney or process server, permission be granted to serve these papers myself, by Certified Mail, Return Receipt Requested. - the attached Order be signed. Sworn to before me this day of 20 Signature of Court Employee and Title, or Notary Public Signature of Petitioner CIV-LT-22 (Revised 4/04) (4ply) American LegalNet, Inc. www.FormsWorkflow.com