Tenants Request For Inspection {CIV-LT-61}

DEPARTMENT OF Civil Court Index No.: LT/HP HOUSING PRESERVATION AND County of: DEVELOPMENT Housing Part: Room: Division of Code Enforcement The case of (Form A-B) vs. will appear on the Court Calendar on: at A.M. TENANTS REQUEST FOR INSPECTION Tenants Name: Tenants Address: Apt. No.: Floor: Tenants Phone Numbers: Home:( ) Work: ( ) You may gain access by contacting: TENANTS ALLEGATION OF VIOLATION DIVISION OF CODE ENFORCEMENT Apt. No. (or Which Room? Condition(s) - BE SPECIFIC Inspectors No.: public area) Date: Signature In connection with the existing case in the Civil Court of the City of N ew York referred to above, I, the tenant of the apartment referred to, wish to call the Courts attention to the conditions listed above which I allege areviolations, and request that an inspection of the property be made to ve rify my allegations. Date of Request: Tenants Signature: Bronx, Harlem & Manhattan Kings, Queens and Richmond An inspector will come to inspect these conditions on:An inspector will come to inspect these conditions but you must first Call the inspectors office to make an appointment. Call: - CIV-LT-61-i (Revised November, 2003) (Replaces A&B) American LegalNet, Inc. www.USCourtForms.com