New York Residential Lease Agreement

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What is a NY Rent Agreement

A Residential Lease Agreemeny (sometimes also known as a rental lease agreement) is a real estate rental contract between a landlord and a tenant. This creates a legally binding accord between the two parties that conforms to the laws of the state that the property is located in (in this case New York). 

The agreement contains details on the following:

  • How long the tenant may legally reside in the property

  • How much rent should be paid

  • Information about the security deposits necessary

  • When rental installments are due

  • Any additional costs that must be serviced by the tenant

  • The rules regarding the proper use of the property

  • Situations that constitute a lease violation eviction procedures

Types of NY Estate Lease Agreements

There are many types of NY lease agreement forms that landlords can choose to rent a property in the state. These allow for owners to flexibly create an arrangement that best suits the type of property they are leasing and the type of tenant they are partnering with.

The most common types of lease agreements in New York include:

  • Residential lease agreement: A fixed-term lease that can last several months or years depending on the agreement between both parties.

  • Lease agreement with option to purchase: In this kind of contract rent-to-own buyers may take up an option written in the lease to purchase the property outright from the current owner.

  • Room rental agreement: This allows people with homes of multiple occupancy with shared living areas to create an agreement for the rental of a single bedroom.

  • Sublease Agreement: With this agreement, tenants can rent the property they are renting to a third party.

  • Room Rental Agreement: This allows people with homes of multiple occupancy with shared living areas to create an agreement for the rental of a single bedroom.

How to Write a New York Lease Agreement

Drafting a legally binding New York Lease Agreement requires including all key information and terms. 

Follow these steps to create a well-written agreement that complies with New York legislation:

  • Name the parties involved: The lease agreement must include the names of both the landlord and tenant(s).

    parties in a lease agreement

  • Include the property’s address and clarify its use: The agreement must clearly state the address of the property and how it will be used.

    property and use of property in a lease agreement

  • List the lease terms: The start and end dates of the lease should be listed, along with any provisions for extending or renewing the lease.

    Terms in a Lease agreement

  • Specify fees and payment: This section should include the rent price, payment method, and due date, as well as any fees for late rent payments.

    Rent and Payment in a lease agreement

  • Add deposit information: The security deposit amount and the timeframe for returning it to the tenant should be specified in this section.

    security deposit in a lease agreement

  • Name the occupants: If there are any non-paying residents living on the property, they must be named in the lease agreement.

    Occupants in a lease agreement

  • Clarify who pays for utilities: This section should define which utilities are the responsibility of the tenant(s) and which are the responsibility of the landlord.

  • Enumerate the furnishings on the property: If the property is furnished, a list of furnishings should be added to the agreement.

    Utilities and furnishing in a lease agreement

  • Indicate the governing law: The lease agreement should state that it will be governed by New York state law.

    Governing law in a lease agreement

  • Include a signature section: Both the landlord and tenant(s) must sign the agreement, including the date of signature and printed name.

    Signatures in a lease agreement

Using a New York Lease Agreement template can simplify the process of drafting an agreement and reduce the likelihood of errors.

New York Estate Rental Laws

A New York lease agreement must conform to the laws of New York state, otherwise, it will be legally contestable and can be declared invalid. To avoid breaking the rules on rentals properties in-state landlords and tenants must check the terms they include carefully to ensure they adhere to standards such as the following: 

  • Landlord’s right to enter: Landlords renting to tenants in New York must provide at least one weeks’ notice of any repairs that will be made to the property and at least 24 hours’ notice before entering for inspections (NY Admin Code § 27-2008). The request to enter should be made in writing and a reason given for the visit.

  • Security deposit: New York landlords may charge no more than one months’ deposit if the property is a non-rent control unit (N.Y. GOB § 7-108-1a(a)). This must be returned to the tenant within 14 days of vacating the property and returning the keys (N.Y. GOB § 7-108-1a(e)). Landlords must also give advance notice of any deductions.

  • NSF Check: According to the General Obligations law of the state of New York (N.Y. GOB § 5-328), landlords may charge tenants a fee of up to $20 if a check received as payment is returned due to insufficient funds or any other reason.

  • Limitation on fees: In New York, landlords can charge fees to cover background and credit checks on potential tenants, but the total fee cannot exceed the actual cost of the checks or $20, whichever is less (N.Y. RPL§ 238-A (2)). Additionally, landlords must provide tenants with copies of checks and the receipts from the entity conducting them.

  • Late rent fees: Landlords in New York (N.Y. RPL § 238-A (2))can only charge late payment fees if the rent has not been paid within five days of the due date. The fee cannot exceed fifty dollars or five percent of the monthly rent, whichever is less.

NY Rental Required Disclosures

New York state requires landlords to disclosure a few important addendums. These are necessary to conform to rental laws and provide important information on a number of safety considerations.

Essential New York Estate Lease Agreement Disclosures

The disclosures below are often included in New York Residential Lease Agreements:

  • Operative fire sprinkler system notice: The lease agreement must contain a notice on whether or not the property being rented has a working sprinkler system. If there is one present its maintenance and repair history must be provided as an addendum (N.Y. RPL § 231-A). 

  • Lead-based paint disclosure: Under federal law, all lease agreements for all buildings built before 1978 must include a disclosure statement on the risks of lead-based paint. This must report any known hazards found on the property. Landlords must also provide the tenant with the appropriate EPA literature on lead-based paint.

  • Security deposit: When tenants deposit or advance money, the landlord must keep it separate from their own funds and hold it in trust. If the landlord credits the money to a bank account, they must inform of the bank's name and address (NY GOB § 7-103).

Mandatory NY Rental Disclosures

The following disclosures are of mandatory compliance for landlords in New York:

  • Bed bugs: This disclosure must explain the bedbug history of the property being rented and of the building that it is located in (NYC Admin Code § 27–2018.1).

  • Allergen hazards: Landlords must make sure that there are no pests or other allergen hazards inside and prevent any conditions that could cause such hazards. If any such conditions arise, the owner must fix them quickly, along with any underlying issues that may exist (NYC Admin Code § 27–2017.1).

  • Window guards: If a child ten years old or younger lives in a dwelling unit in a multiple dwelling, the owner of the building or unit in a condominium must provide, install and maintain a window guard on each window of the unit. This includeswindows in public areas (NYC Admin Code § 27–2043.1). 

  • Stove knob covers: Landlords must give tenants with gas stoves the choice of using permanent stove safety knobs with built-in locks or stove knob covers for each knob located on the front of the stove if there is a child under six living in the dwelling unit (NYC Admin Code § 27–2046.4).

  • Smoking policy: Landlords must adopt a smoking policy. This must include where smoking is allowed or not allowed, both inside and outside the building, including in common areas, individual apartments, and outdoor areas like courtyards and balconies (NYC Admin Code § 17-506.1).

  • Anti-scald valves: Baths and showers that have balanced-pressure mixing valves, thermostatic mixing valves, or a combination of pressure balancing/thermostatic valves shall produce water that is less than 120 degrees Fahrenheit, but not lower than 110 degrees (NYC Admin Code § 27-2031).  

Other Recommended NY Disclosures

New York law does not mandate the following lease agreement disclosures and addendums. However, landlords may find it beneficial to include them in order to minimize potential disputes with tenants or limit legal responsibilities.

Disclosure Benefits of the Disclosure Law
Asbestos This disclosure notifies tenants of the presence of asbestos on the property and take precautions. The New York Asbestos Disclosure Act
Landlord’s Name & Address This provision establishes a means of communication for crucial notices and requests between tenant and landlord. The landlord or any authorized representative should add their contact details to the lease. New York General Obligations Section 5-703(2)
Bounced Check/Late Fees Landlords should disclose in the agreement if they will impose a late fee or a returned check fee. In New York, returned check fees are limited to $20 per check, and late fees are capped at $50 or 5% of the rent amount, whichever is greater. New York Real Property Law Section 238-a
Use of Medical Marijuana Notify tenants whether the use of medical marijuana is allowed on the property. In some states, landlords may limit marijuana consumption to non-smoking methods or designate smoking areas to avoid disrupting other tenants. New York City: Local Law 147

New York State: New York Marijuana Regulation and Taxation Act (“MRTA”)

Mold Disclosure By informing the tenant of the existing mold status of a property, landlords can protect themselves from potential liability for mold damages. New York City Local Law 55
Contents Checklist A contents checklist, also called a move-in checklist, helps ensure that the tenant is responsible for any damages that may occur during their tenancy. Not required by law, but it is highly recommended.
Non-Refundable Charges It is necessary to include a non-refundable charge in the lease agreement. If it is not included, the tenant may be entitled to a refund when the lease is terminated. There are no laws prohibiting non-refundable fees. However, non-refundable fees should be included in the agreement to bind the tenant to the non refundability of fees.
Shared Utilities If utilities are shared between tenants in a rental property, the landlord must specify this information in the lease agreement, along with the formula used to determine each tenant's share of the cost. New York Shared Meter Law, N.Y. Pub. Serv. Law § 52(1)(b)
Smoking Let tenants know about designated smoking areas to ensure that they don't disrupt other tenants. The New York State Clean Indoor Air Act

and NYC, N.Y., Ord.1585A-2017

New York Residential Lease Agreement Sample

Before starting your own New York Residential Lease Agreement it is important to clearly understand the layout and language of the document. Use our lease agreement sample below to familiarize yourself with the necessities of this important legal contract.

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Residential Lease Agreement New York Sample

Other Real Estate Documents

Besides lease agreements, there are various other legal documents that are commonly used by landlords. If you are the owner of a rental property, one of the following forms may be helpful for you: 

NY Residential Lease Agreement FAQs

There are many considerations that need to be clear before creating a Residential Lease Agreement from scratch. Read through the answers to our FAQs below to understand the specifics of renting and leasing properties in New York better.

How to Get a New York Lease Agreement Form?

It is possible to create your New York Lease Agreement fully online. Using our legal document maker tools, you can easily construct your own tailored lease with the help of step-by-step guidance and professional templates.

Alternatively, this form can be created with the help of an attorney or law office. This option however comes at a higher cost from hiring a legal profession.

How to End a Lease Agreement in NY?

In most cases, Lease Agreements in NY end naturally when they reach their expiry date. If for any reason either party needs to end the contract early, they must submit a termination lease letter, explaining when and why the break is to occur. 

NY lease agreements often carry high financial penalties if they are broken or ended early. However, there are a number of situations that allow a tenant to end their agreement before its expiry without any extra costs, these include:

  • Entering active military service.

  • Tenants over 62 years old entering residential healthcare facilities.

  • The landlord refuses to make substantial repairs.

  • The tenant has been a victim of domestic abuse or stalking.

  • The landlord has violated the privacy of the property or is harassing the tenant.

Do I Need to Notarize my NY Residential Lease Agreement?

It is not necessary to notarize a NY Residential Lease Agreement. However, whilst this might not be a legal requirement in New York state, signees are still advised to consider this step to provide further legal enforceability.

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Residential Lease Agreement New York Sample

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NEW YORK
RESIDENTIAL LEASE AGREEMENT

This Lease Agreement (hereinafter, the "Lease Agreement") is dated as of _________ (hereinafter, the "Effective Date") and is entered into by and between _________ (hereinafter, the "Landlord") and the following residents:

_________
(hereinafter, the "Tenant(s)").

The Landlord and the Tenant(s) agree as follows:
1. PROPERTY

A. The Landlord is the owner of certain real property and improvements described as a house located at _________, _________, New York _________ (hereinafter, the "Property").

B. The Landlord rents to the Tenant(s) and the Tenant(s) rents from the Landlord the Property according to the terms and conditions described in this Lease Agreement.

C. Unless otherwise indicated in the Lease Agreement, no other portion of the building (hereinafter, the "Building") is included in the Lease.

D. Unless otherwise indicated in the Lease Agreement, the Property is for the sole use as a personal residence by the person(s) named above only.
2. TERM

The term of the Lease Agreement begins on _________ (hereinafter, the "Commencement Date"), and shall continue from that date as a month-to-month tenancy.

Either party may terminate the tenancy by giving the other party written notice of intention to terminate the tenancy at least 30 days prior to the intended termination date. Such notices may be given on any date.
The Tenant(s) shall vacate the Property upon termination of the Lease Agreement, unless:

(i)The Landlord and the Tenant(s) have, in writing, extended this agreement or signed a new agreement;
(ii)Mandated by local rent control law; or
(iii)The Landlord accepts Rent from the Tenant(s) (other than past due Rent), in which case a month-to-month tenancy shall be created which either party may terminate. In this case, the Landlord or the Tenant(s) may terminate the tenancy by giving written notice at least 30 days prior to the intended termination date to the other party. All other terms and conditions of the Lease Agreement shall remain in full force and effect until terminated, any changes made pursuant to New York Law excepted.
3. MANAGEMENT

The Tenant(s) is hereby notified that the Owner or Landlord _________ is the property manager in charge of repairs or maintenance of the Property.

If the Tenant(s) has any complaint regarding any issue about the Property, _________ shall be contacted by one of the following methods:
Address: _________
Telephone: _________
Email: _________
4. RENT

The Tenant(s) shall pay the Landlord monthly rent in the amount of $_________ (hereinafter, the "Rent") for each full month during this lease. The full month's rent is due and payable not later than the 1st day of each month. If that day falls on a legal holiday, the rent is due on the next business day.

If this Lease Agreement is for a Non-Rent Regulated property, the Landlord will be able to charge any rent agreed upon by the parties.

If this Lease Agreement is for a Rent regulated property, the initial rent and subsequent rent increases are set by law, and may be challenged by a tenant at any time. However, recovery of rent overcharge is limited to either four or six years preceding the complaint, depending on when the complaint is made.
Place of Payment:

The Tenant(s) shall remit all rent payment amounts owed to the Landlord under this Lease Agreement to the Landlord and make all amounts payable to the following address:

_________

The landlord may later change the person and place to which the Tenant(s) must remit the rental amounts due under this Lease Agreement.
Method of Payment:

The Tenant(s) shall pay all rent by selecting any of the following forms of payment (select one or more):
In the event that the Landlord agrees that the Tenant(s) shall have the right to sub-let the Property or any part thereof, or in the event that the Property is leased under any form of multiple or joint tenancy, the Tenant(s) shall be responsible for collecting the lease payment from the sublessee(s) or joint lessee and submitting it to the landlord in a single and complete payment.

Moreover, the Tenant(s) shall be responsible for any lease payment not received by the Landlord by the due date stated in the present Lease Agreement. All partial payments made for an incomplete monthly period shall be pro-rated at the rate of 1/30th of the monthly lease payment per day.

Lastly, the Landlord shall have the option to accept or reject payments made by third parties, but such acceptance or rejection of payment shall not imply a future obligation to accept or reject payments submitted by third parties.
5. RENT ADJUSTMENTS

If a Landlord of a non-rent regulated property intends to increase the rent by more than 5%, or does not intend to renew the tenancy, they must provide advanced written notice of:

        Thirty (30) days: if the tenant has occupied the unit for less than one year.
        Sixty (60) days: if the tenant has occupied the unit for more than one year but less than two years.
        Ninety (90) days: if the tenant has occupied the unit for more than two years.

If the Landlord of a rent regulated property intends to increase the rent, they must comply with the requirements and the maximum rent increases set each year by local Rent Guidelines Boards. In such case, if the Landlord believes he or she has grounds for an increase in rent due to economic hardship, or as a result of having undertaken a Major Capital Improvement or an Individual Apartment Improvement, he or she must file an application with the State Division of Housing and Community Renewal ("authorized agency").

The "authorized agency" will decide if the request is warranted. If the Landlord is entitled to an increase in rent or any other relief, it shall be binding upon the tenant. However, if the tenant believes that he or she has been overcharged, such tenant must file an overcharge complaint with the Office of Rent Administration or cancel the lease agreement by giving the Landlord a sixty (60) days written notice.
6. OCCUPANTS

In accordance with the New York Consolidated Laws, Real Property Law § 235-f, the tenant(s) shall inform the Landlord of the name of any occupant within thirty (30) days following the commencement of occupancy by such person or within thirty (30) days following a request by the Landlord.

However, no occupant nor occupant's dependent child shall, without express written permission of the Landlord, acquire any right to continued occupancy in the event that the tenant vacates the premises or acquire any other rights of tenancy.
7. SMOKING

Smoking is not allowed in or on any area of the Property, including individual units and common areas, both indoors and outdoors. This policy applies to all owners, tenants or guests.

If the Tenant(s) contravenes this provision by smoking or allowing guests to smoke in any place on the property, then such Tenant(s) shall be held liable for any damages caused to the Property or the Property. The violation of this provision shall be considered a just cause for the eviction of the Tenant(s) by the Landlord.

This restriction includes the use of e-cigarettes and vaping.
8. MAINTENANCE

The Landlord will have the responsibility to maintain the Property in good condition at all times and perform all repairs reasonably necessary to meet the implied warranty of habitability of the Property, that is, that the property is in a safe and livable condition.
9. REPAIRS

All requests for repairs must be in writing and delivered to the Landlord. Only in the event of an emergency related to the condition of the Property that materially affects the physical health or safety of an ordinary tenant, the Tenant(s) may call the Landlord.

The Tenant(s) may not repair or cause to be repaired any condition, regardless of the cause, without the Landlord's permission. All decisions regarding repairs, including the completion of any repair, whether to repair or replace the item, and the selection of contractors, will be at the Landlord's sole discretion.

If, in an emergency, it shall become necessary to make any repairs or replacements by the Tenant(s) without prior written consent from the Landlord, at Landlord's expenses, and such repairs or replacements are found to be unsatisfactory and to have caused additional damages, the Tenant(s) shall reimburse Landlord for the cost of making such repairs.
10. UTILITIES AND SERVICES

The Tenant(s) shall be solely responsible for and shall pay expenses for all utilities and services used or consumed at the Property.
11. NEW YORK HEAT SEASON AND HOT WATER

During the heat season of each year (from October 1 through May 31), the Landlord is required by law to:

1) Maintain indoor temperatures at 68 degrees when outdoor temperatures fall below 55 degrees during the day; and
2) Maintain Indoor temperatures at 62 degrees overnight, regardless of outdoor temperatures.

The Landlord will also provide hot water at 120 degrees year-round.
12. ALTERATIONS AND IMPROVEMENTS

The Tenant(s) shall not make any alterations, additions, redecorations or any sort of improvements on the leased Property without the Landlord's prior written consent. All additions, alterations, fixtures or improvements made by the Tenant(s), except movable household furniture, shall become the Landlord's property and remain on the Property as part of the Property and shall be surrendered with the leased premises at the Termination of this Lease Agreement.
13. HAZARDOUS MATERIALS

The Tenant(s) shall not keep or have on the Property any article or item of a dangerous, flammable, or explosive material that might unreasonably increase the danger of fire or explosion on the Property or that might be considered hazardous or extra hazardous by any responsible insurance company.
14. LANDLORD ACCESS TO PROPERTY

The Landlord and the Landlord's agents shall have the right at all reasonable times, and by all reasonable means during the term of this Lease Agreement and any renewal thereof, to enter the Property for the following purposes:

a. Survey the Property's condition and take photographs to document the condition.
b. Make repairs or improvements to the Property.
c. Supply agreed services.
d. Show the Property to prospective buyers or tenants.
e. Exercise a contractual or statutory lien.
f. Leave a written notice.
g. Seize nonexempt property if the Tenant(s) is in default.

Except in case of emergency, the Landlord will give the Tenant(s) reasonable notice of intent to enter. For these purposes, twenty-four (24) hour written notice will be deemed reasonable.
15. ASSIGNMENT / SUBLETTING

The Tenant(s) shall not assign or sublet this Lease Agreement, grant any license to use the Property or any interest in the Property or any part thereof, nor mortgage or pledge this Lease Agreement, without the prior written consent of the Landlord, which will not be unreasonably withheld. The Tenant(s) shall inform the Landlord of his intent to sublease in the manner required by Real Property Law §226-b.

In accordance with New York Consolidated Laws, Real Property Law - RPP §226-b the Landlord shall send a notice to the tenant of his consent or, if he does not consent, his reasons therefor within thirty (30) days after the mailing of the request for consent, or of the additional information reasonably asked for by the landlord, whichever is later. The Landlord's failure to send such a notice shall be deemed to be a consent to the proposed subletting.  

If the Landlord consents, the Property may be sublet in accordance with the request, but the Tenant(s) thereunder, shall nevertheless remain liable for the performance of the tenant(s)'s obligations under this Lease Agreement.

If the Landlord reasonably withholds consent, there shall be no subletting and the Tenant(s) shall not be released from the lease.  

If the landlord unreasonably withholds consent, the Tenant(s) may sublet in accordance with the request and may recover the costs of the proceeding and attorneys' fees if it is found that the Landlord acted in bad faith by withholding consent.
16. NOTICES

Notice required by statute will be given in accordance with the applicable statute. All other notices shall be deemed sufficient if made as follows:

(i) All notices to the Landlord shall be directed by personal delivery or first-class mail to the Landlord at the appropriate address set forth below, until Tenant is notified, in writing, to the contrary.

(ii) All notices to the Tenant(s) shall be directed by personal delivery or first-class mail to the Tenant(s) at the leased Property or any forwarding address provided in writing by the Tenant(s) to the Landlord.
Landlord:

_________
_________
Tenant:

_________
_________, _________, New York _________
Such addresses may be changed from time to time by any party by providing notice as set forth above.
17. VENUE AND GOVERNING LAW

Exclusive venue is in the county where the Property is located. This Lease Agreement shall be governed, construed and interpreted by the Laws of the State of New York.

IN WITNESS WHEREOF, the Landlord and the Tenant(s) have executed this Lease Agreement in the manner prescribed by law as of the Effective Date.
Landlord:

By: ____________________________ Date: ______________
     _________
Tenant:

By: ____________________________ Date: ______________
      _________
Operative Fire Sprinkler System Disclosure
Address: _________, _________, New York _________.

Pursuant to the New York State Real Property Law, Article 7, Section 231a, effective December 3, 2014 all residential leases must contain a conspicuous notice as to the existence or non-existence of a Sprinkler System in the Leased Premises.
A "Sprinkler System" is a system of piping and appurtenances designed and installed in accordance with generally accepted standards so that heat from a fire will automatically cause water to be discharged over the fire area to extinguish it or prevent its further spread (Executive Law of New York, Article 6-C, Section 155-a(5)).
There is NO Maintained Operative Sprinkler System in the Leased Premises.
Tenant acknowledges that it has read the above statements as to the Sprinkler System and that the information as to the existence or non-existence of a Sprinkler System is being provided to Tenant in accordance with New York State Real Property Law Article 7, Section 231-a.
Landlord:

By: ____________________________ Date: ______________
     _________
Tenant:

By: ____________________________ Date: ______________
      _________
New York Lease Agreement Inspection Checklist
Address: _________, _________, New York _________

The Tenant(s) has inspected the Property and states that the Property is in satisfactory condition, free of defects, except as noted below:
SATISFACTORYCOMMENTS
Bathrooms  __________________________________
Carpeting  __________________________________
Ceilings  __________________________________
Closets  __________________________________
Countertops  __________________________________
Dishwasher  __________________________________
Disposal  __________________________________
Doors  __________________________________
Fireplace  __________________________________
Lights  __________________________________
Locks  __________________________________
Refrigerator  __________________________________
Screens  __________________________________
Stove  __________________________________
Walls  __________________________________
Windows  __________________________________
Window coverings  __________________________________
___________________________________________
___________________________________________



_____________________

Date

Tenant:

By: ____________________________ Date: ______________
      _________
Acknowledged by Landlord:
By: ____________________________ Date: ______________
     _________
Annual Notice Regarding Installation of Stove Knob Covers
This Stovetop Protection Notice regards the property with the following address:
_________, _________, New York _________.

The owner of this building is required, by Administrative Code §27-2046.4(a), to provide stove knob covers for each knob located on the front of each gas-powered stove to tenants in each dwelling unit in which a child under six years of age resides, unless there is no available stove knob cover that is compatible with the knobs on the stove. Tenants may refuse stove knob covers by marking the appropriate box on this form. Tenants may also request stove knob covers even if they do not have a child under age six residing with them, by marking the appropriate box on this form. The owner must make the stove knob covers available within 30 days of this notice. Please also note that an owner is only required to provide replacement stove knob covers twice within any one-year period. You may request or refuse stove knob covers by checking the appropriate box on the form below, and by returning it to the owner at the address provided. If you do not refuse stove knob covers in writing, the owner will attempt to make them available to you.

Please complete this form by checking the appropriate box, filling out the information requested, and signing. Please return the form to the owner at the address provided by such owner.

(INSERT DATE): _________________________, 20____.

☐ - Yes, I want stove knob covers or replacement stove knob covers for my stove, and I have a child under age six residing in my apartment.
☐ - Yes, I want stove knob covers or replacement stove knob covers for my stove, even though I do not have a child under age six residing in my apartment.
☐ - No, I DO NOT want stove knob covers for my stove, even though I have a child under age six residing in my apartment.
☐ - No, I DO NOT want stove knob covers for my stove. There is no child under age six residing in my apartment.
☐ - No, I DO NOT want stove knob covers for my stove because I have them already.

___________________________________ (Tenant Signature) ____________ (DATE)

Print Name, Address, and Apartment Number:
_______________________________________________________________________________________________________________________________________________

Return this form to: (Owner address):
_______________________________________________________________________________________________________________________________________________
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