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Eviction Intake SH-0611 - New York

Eviction Intake Form. This is a New York form and can be used in Civil Court New York Local County .
 Fillable pdf Last Modified 4/22/2014
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NYC Department of Finance Instructions: Please attach a copy of your Court/Judgment/Order to this form. Read the entire page before completing and see reverse side for information regarding borough locations of the Office of the Sheriff. SECTIONI - lANdlORd INFORMATION PRINT FIRST NAME Mail to: County Office of the Sheriff where the services are to be made. County Sheriff locations are listed on the reverse side. EVICTION INTAKE l Office of the Sheriff THE SERVICE FEE IS $135.00 FOR EVICTION ($15.00 for each Additional Tenant) PRINT LAST NAME Address: ___________________________________ City: ___________________ State: ______ ZipCode: ________ The Judgment of Possession was obtained in the following Court: SECTIONII - COuRT INFORMATION NUMBER AND STREET APT. NO. Telephone Landlord: ____________________________________________________ Number: __________________________ q Court Address and County: ___________________________________ City: ________________ State: ______ ZipCode: ________ Tenant To Telephone No. Be Evicted: ___________________________________________________ (if known): _________________________ PRINT FIRST NAME PRINT LAST NAME NUMBER AND STREET APT. NO. Court Date of Entry Index: _________________________________________________ of Judgment:________-________-________ MM DD YYYY NUMBER AND STREET COUNTY CIVIL COURT q LANDLORD/TENANT COURT q SUPREME COURT q OTHER COURT SECTIONIII - SubJECT INFORMATION AT RISk INFORMATION: Is any party being evicted elderly (over 60), handicapped or mentally infirm? If yes, please state condition: Address: _______________________________________________ Borough: _______________ ZipCode: ________ q _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ YES q NO Indicate below any information which may be helpful in effecting a prompt and safe eviction of the tenants: i.e., best time to serve 72 hour notice, criminal activity at location, threats of violence, animals or any other behavior or circumstance. _______________________________________________________________________________________________ _______________________________________________________________________________________________ SECTION V - CERTIFICATION The undersigned hereby affirms to the best of his/her knowledge that the eviction mandate being filed is in full effect, and request is made to the Sheriff for its enforcement by statutory authority. _____________________________________________________________ Landlord/Agent's Signature: __________________________________________ Date: SH-0611 American LegalNet, Inc. www.FormsWorkFlow.com SECTIONIV - gENERAl INFORMATION _______________________________________________________________________________________________ Visit Finance at nyc.gov/finance Rev. 3.19.14 OFFICE OF THE SHERIFF COUNTY LOCATIONS NEw YORk Office of the Sheriff 66 John Street, 13th Floor New York, NY 10038 (212) 487-9734 bRONx Office of the Sheriff Bronx Customer Service Center 3030 Third Avenue, 2nd Floor, Bronx, NY 10455 (718) 993-3880 kINgS Office of the Sheriff Brooklyn Municipal Building 210 Joralemon Street, 9th Floor Brooklyn, NY 11201 (718) 802-3545 QuEENS Office of the Sheriff 30-10 Starr Avenue Long Island City, NY 11101 (718) 610-0448 (718) 610-0454 INCOME EXECUTION LOCATION Office of the Sheriff 66 John Street, 13th Floor New York, NY 10038 (212) 487-8002 RICHMONd Office of the Sheriff Staten Island Business Center 350 St. Marks Place, Room 409 Staten Island, NY 10301 (718) 815-8407 American LegalNet, Inc. www.FormsWorkFlow.com CONSTRUCTIVE POSSESSION COURT OF THE STATE OF NEW YORK NYC Department of Finance l Office of the Sheriff COUNTY OF __________________________ ______________________________________________ Plaintiff/Petitioner/Landlord ______________________________________________ Defendant/Respondent/Tenant VS. SHERIFF'S CASE # DOCKET/INDEX # Pursuant to this direction, plaintiff(s)/petitioner(s)/landlord(s) release the Sheriff and/or his Deputies from any liability and agrees to save the Sheriff and/or his Deputies harmless from any action resulting from the enforcement of this mandate. _______________________________________________ Signature _______________________________________________ Print Name _______________________________________________ Telephone # Visit Finance at nyc.gov/finance Pursuant to the order/warrant herein, you are directed to give the plaintiff(s)/petitioner(s)/landlord(s) possession by delivering such without removing any contents. Plaintiff(s)/petitioner(s)/landlord agree to be responsible for all property on the premise and agree to deliver to defendant(s)/respondent(s)/tenant(s) upon their demand, any such contents to which they are entitled. To the Sheriff of the City of New York: SH-0524 3.4.14 American LegalNet, Inc. www.FormsWorkFlow.com COUNTY OF _______________ CIVIL COURT OF THE CITY OF NEW YORK HOUSING PART: ______________ Index No. L & T___________ ______________________________________________ Petitioner/Landlord ______________________________________________ Respondent/Tenant AGAINST REQUEST FOR FINAL ORDER AND ISSUANCE OF WARRANT YOU ARE HEREBY REQUESTED TO SUBMIT THE PAPERS IN THE ABOVE ENTITLED PROCEEDING TO THE JUDGE FOR A FINAL ORDER/JUDGMENT, IF NECESSARY, SO THAT A WARRANT OF EVICTION MAY ISSUE TO THE SHERIFF OF THE CITY OF NEW YORK. ____________________________________ (Print name beneath signature) To the Clerk of the Civil Court of the City of New York. County of _______________________ Date: ___________________, 20_____ Visit Finance at nyc.gov/finance SH-0521 3.3.14 American LegalNet, Inc. www.FormsWorkFlow.com
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