Read SCRIE Annual Adj Rent Controlled Apts text version

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Finance

Instructions: Use this form if you are an owner/agent with updated Fuel Cost (FCA) or Maximum Collectible Rent (MCR) or Maximum Base Rent (MBR) information for SCRIE tenants. Please complete this form for each affected building and attach DHCRapproved increase documentation.

Mail to: NYC Department of Finance, 59 Maiden Lane, 22nd Floor, New York, NY 10038

SCRIE ANNUAL OWNER / AGENT ADJUSTMENT FOR

NYC DEPARTMENT OF FINANCE

RENT CONTROLLED APARTMENTS

G

TAX AND PARKING PROGRAM OPERATIONS

1. Owner / Agent: a. ____________________________________________ b. _________________________________________ 2. Contact Person Phone Number: (_____)____________________________

Company Name

SECTION I - APPLICANT INFORMATION

Extension: __________________________

Contact Person

3. Contact Person Email Address: ________________________________________________________________________ 4. Mailing Address: ____________________________________________________________________________________ _______________________________________________________________ _____________

CITY STATE NUMBER STREET NAME NUMBER STREET NAME ZIP CODE

_________________

5. Building Property Address:____________________________________________________________________________ _______________________________________________________________ _____________

CITY STATE ZIP CODE

_________________

6. Building Borough: _________________

Block: ____________________________________

Lot:________________

7. SCRIE Docket Number(s): ____________________________________________________________________________ Please attach additional sheet if needed.

_________________________________________________________________________________________________

1. Reason for Adjustment (check all applicable boxes): SECTION III - CERTIFICATION

Increases for FCA, MCR and MBR must be authorized by DHCR. Please specify which type of increase(s) you are requesting for the tenant(s) listed above.

SECTION II - EXEMPTIBLE INCREASE

K Fuel Cost Increase

K Maximum Collectible Rent

K Maximum Base Rent

Signature of Owner / Agent

____________________________________________________________ ______________________________________ ____________________________________________________________ ______________________________________

Date

SCRIE Annual Adj Rent Con 05.26.11

I certify that all information contained in this application is true and correct to the best of my knowledge and belief. I understand that willful making of any false statement of material fact herein will subject me to the provisions of law relevant to the making and filing of false instruments and will render this application null and void.

Date

Signature of Preparer (If other than owner / agent)

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SCRIE Annual Adj Rent Controlled Apts

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SCRIE Annual Adj Rent Controlled Apts