NYC 9/11 Public Portal Document
J -Narp.'i Address
Citv- State.
5. Managing Agent or Broker, if any:
Name: _
Address:
City: State: Zip Code
Q. Landlord’s Real Estate Background
6. If landlord has filed a disclosure statement with the City within the past 12 months state date of filing, address
of property and explain any material change which has occurred since the previous filing:
7. List all property owned or managed by landlord in NYC within the last five years, including name and address
of owner of record for each property managed by landlord.
Address:
Borough: Block and Lot:
Owner: _
Address:
City: State: Zip Code:
Address:
Borough: Block and Lot:
Owner: _
Address:
City: State: Zip Code:
7A. Landlord must complete the attached Credit Information Authorization Form and attach a description of any
mortgage or other liens against the premises.
8. Are any of the properties owned or managed by landlord in arrears with respect to the following obligations, if
so identity the property and amount owed:
Property Amount owed
Real Estate Taxes
Water/Sewer Rents and Charges
Other municipal or government charges
9. Has any property owned or managed by landlord, or by any business entity in which applicant is/was a partner
or principal, been involved in a foreclosure proceeding within the past 10 years?
Yes □ No □
If yes, identity the property, date of the commencement of the foreclosure proceeding and circumstances;
Address: _______
Borough: _______ Block and Lot:
Date of foreclosure:
Comments:
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NYC-WTC_000170986
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