NYC-WTC_000166105

NYC 9/11 Public Portal Document

INDICATE CHANGES BELOW LEASE PRIMire. INFORMATIL,IJ PREMISES ADDRESS

ADDITIONAL PREMISES INFO

STREET NUMBER PREFIX W

STREET NAME

TYPE SUFFIX BORO m ziP I l I l l I l l I l AKA ADDRESS

STREET NUMBER I I PREFIX I

STREET NAME

TYPE SUFFIX ] m

ACCOUNT NAME (CIN) - OWNER NAME (CIO) X - IF CHANGE IN NAME ONLY

X - IF CHANGE IN OWNER

DATE OF OWNER CHANGE I I L-1 171 I MAILING ADDRESS (CIMA)

ADDITIONAL MAILING INFO

STREET NUMBER PREFIX I

STREET NAME

SUFFIX l I l i BORO TYPE I I I ziP l i l l i l ENTER HERE FOR OUT OF TOWN ADDRESS (CIMA)

CITY I 1 I I I i I I I I I I I I I 1 STATE I I I ZIP

REMARKS

INS D. COMMENTS INSPECTOR DATE

EXAMINER DATE ' ~~ ~ ~ ENTRY CLERK DATE N~

AUDITOR DATE

COMMENTS DATE INSPECTOR I.D. INSPECTOR EXAMINER DATE

ENTRY CLERK DATE

AUDITOR DATE

NYC-WTC 000166131