NYC 9/11 Public Portal Document
/Department of cityavide administrative services
DIVISION OF REAL ESTATE SERVICES
Landlord Disclosure Form
FOR AGENCY USE ONLY
DRES Project No._______________
Agency for which property will be used:
INSTRUCTIONS
• If applicant is the landlord (owner of record), complete the Landlord Disclosure Form BOA-1
• If the applicant is the Sub-Landlord, complete both the Landlord and Sub-Landlord Disclosure Forms BOA 1 & 2
Property to be leased
Address:
Borough:
Block and Lot:
Zip Code:
Floor(s)/Room:
NOTE: If additional space is needed to complete any question(«), attach and reference the selected number of
additional sheets.
I. Identity of Landlord
1. Name;
Address:
Borough;
Zip Code;
2. Federal Tax Identification Number:
3. Landlord’s Legal Status:
Individual, Sole Proprietor Corporation
_________ Partnership Not-For-Profit
3a. Corporate Landlord - Attach a Certificate of Good Standing.
Individual / Sole Proprietor or Partnership - Attach Certificate of Doing Business Under an Assumed
Name (Business Certificate).
4. If a Partnership, names and addresses of partners (including limited partners of 10% or more);
If a Corporation, names and addresses of principals (officers and directors) and owners of 10% or more of the
outstanding shares;
Note; If partner or corporate shareholder is another partnership or corporation, provide names and
addresses of principals (corporate officers and directors and/or names of individual partners).
If a Not-For-Profit, names and addresses of officers and directors:
a. Name: Address:
City: . State: _
b. Name; Address;
City: _ State:
c. Name: Address;
City: _ State: _
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NYC-WTC_000170985
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