Cooper Square Realty, Inc.

6 East 43rd Street · New York, NY 10017-4609

Phone: 212-634-8900 · Fax: 212-634-3946

The Fitzgerald Condominium — Lease Application

Dear Prospective Resident:

Thank you for your interest in The Fitzgerald Condominum!

Enclosed is your Lease Application. Please complete and forward the application, along with
the required documents, to Cooper Square Realty, Inc. 6 East 43rd Street, 14th Floor, New
York, NY for processing.
It is important that you urge your references to submit their letters of reference to you as soon as
possible, since your application cannot be processed until they are received.

If you have any questions regarding your application, please contact Cooper Square
Realty, Inc.'s Application Processor at (212) 634-8900.

Again, thank you for your interest in The Fitzgerald Condominum! We look forward to
hearing from you.

Sincerely,

COOPER SQUARE REALTY, INC.

Transfer Department

02/20/07 01:13 PM
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

The Fitzgerald Condominium — Important Information

and Required Documents
The following is a list of the items you are required to submit for the board to review your application. Please be sure to provide all the
information requested. Items missing will only delay the Managing Agent’s review and submission to the Board.

Important Information (Please read carefully before completing your application)

Please submit one (1) original of the completed application package. Incomplete packages will not be forwarded to the Board.
THE APPLICANT INFORMATION AND FINANCIAL INFORMATION FORMS MUST BE TYPED OR PRINTED LEGIBLY WITH BLACK
INK.

Cooper Square Realty realizes that this application contains sensitive personal information. We require the social
security number for each applicant (and each other adult occupant of the apartment) on the Authorization to
Obtain Consumer Reports Form. This is the only place on the application requiring a social security number, but
social security numbers may be contained in other documents that you are submitting (e.g. tax returns, contracts
of sale). Before submitting these documents, please black out or otherwise obliterate the social security number
as Cooper Square Realty can not be responsible for the security of this information if it is included in these
documents.

• A personal interview is required after application materials are submitted and reviewed.
• Moving company must submit Certificate of Insurance (binder) evidencing $1,000,000.00 comprehensive
public liability, including $1,000,000.00 property damage liability and worker’s compensation and employees
liability covering all employees and sub-contractors. Certificates of insurance should evidence that the
Condominium Association, Cooper Square Realty and unit owner are named as additional insured. Must be
submitted to Ezra Bennett, Property Manager.

Complete the following enclosed forms and return:

___ 1. Applicant Information for Lease- This form must be filled out in its entirety in order for your application to be considered for
review. All applicants and guarantors are required to complete Part 1
___ 2. Fee Acknowledgement Form – must be signed by all applicants and guarantors.
___ 3. Financial Information- This form must be filled out in its entirety in order for your application to be considered for review. All
applicants and guarantors are required to complete Part 2.
___ 4. Consumer Report Authorization- must include social security number, birth date and a US residence (no PO Boxes). Every
adult (over 18 years of age) occupant of the apartment must submit a consumer report authorization.
___ 5. Notice of Intention to Lease
___ 6. Move-in Rider
___ 7. Notification of Legal Mailing Address
___ 8. Window Guard Rider Form – with complete address and correct boxes checked
___ 9. House Rules Acknowledgement
___ 10. Lease Agreement with Rider – must be REBNY

Each applicant will be required to contribute the following documents: (Documents will not be returned)
___ 1. Employment Verification Letter (stating annual salary, position held, length of employment). If you are self employed, please
submit a letter from your CPA or accountant stating your income.
___ 2. Federal Tax Returns (past 2 years)- including your signature and all schedules. After April 15th, you must include the most
recent year's taxes OR a copy of your extension filing and the two most recent year's tax returns.
___ 3. W-2 forms
___ 4. Landlord Reference Letter-must state length of residence and payment history.
___ 5. Two (2) Financial Reference Letters
___ 6. Two (2) Personal Reference Letters

Additional Information (Enclosed for your information. Do not submit with application)
1. Local Law #1 Lead Based Paint Disclosure Booklet
2. House Rules and Regulations
3. "Protect Your Family from Lead in Your Home" Pamphlet
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

The Fitzgerald Condominium — Lease Fees

The following is information about the board application process and a schedule of fees. Please review this information before
completing your application.

Schedule of Fees - Due at submission:

Payable by Applicant
1. $700.00 Application Processing Fee (non-refundable) payable to Cooper Square Realty, Inc. Includes one credit
report per application. Renewing or extending a current lease fee is $000.

2. $75.00 Consumer Report Fee (per ADDITIONAL report) (non-refundable) payable to Cooper Square Realty, Inc. All
applicants, guarantors, and adult occupants must have a consumer report. This building includes ONE credit
report per application. Additional applicants, guarantors, and adult occupants must submit this fee.

3. $112.50 Document Production Fee (non-refundable) payable to Cooper Square Realty, Inc.

4. $200.00 Move-In Fee (Due at application submission) (non-refundable) payable to The Fitzgerald Condominum.

5. $1,000.00 Move-In Deposit (Due at application submission) (refundable) payable to The Fitzgerald Condominum.
Deposit will be refunded after moving inspection by managing agent if no damage has occurred during move.

Payable by Shareholder(s)
1. $200.00 Move-Out Fee (Due at application submission) (non-refundable) payable to The Fitzgerald Condominum.

2. $1,000.00 Move-Out Deposit (Due at application submission) (refundable) payable to The Fitzgerald Condominum.
Deposit will be refunded after moving inspection by managing agent if no damage has occurred during move.

Fees Acknowledgement
I (we) hereby acknowledge that all fees paid pursuant to this lease application are non-refundable, unless otherwise noted, and
hereby authorize you or your agents to obtain a credit report and related information and contact any references or employers listed
herein

X
Applicant Date

X
Co-Applicant (if any) Date
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

Part 1 - Applicant Information for Lease

Applicant Information
Today's date: Requested move-in date:
Building name: The Fitzgerald Condominium Apartment number:
Unit address:
Lease term: to
Length of lease: Annual rent:
Monthly rent:
Security:
Special conditions (if any):
Managing agent: Cooper Square Realty, Inc. Phone: 212-634-8900
Inc. Agent address: 6 E 43rd Street Contact person: Application Processor

Unit Owner(s) Shareholder(s)

Name(s):

Current address: Phone:

E-mail:

Mailing address if lease approved (if different)

Reason for Sublease:

Lessor’s Broker: Phone:

E-mail:

Applicant(s)
Applicant:
Office phone: Home phone:
E-mail:

Co-Applicant:
Office phone: Home phone:
E-mail:

Lessee’s Broker: Phone:

E-mail:

Housing History
Current landlord: Phone:
Address: Rent:
Dates of occupancy:
Reason for moving:

Previous landlord: Phone:

Address: Rent:
Dates of occupancy:
Reason for moving:
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

Applicant(s) Personal Information

Applicant Co-Applicant
Applicant name:
Address:

Dates of residence:
US Citizenship: Yes No Yes No
Employment Status: Full-time Part-time Unemployed Full-time Part-time Unemployed
Retired Student Retired Student
Nature of business:
Current employer:
Employer’s Address:

Are you self employed: Yes No Yes No

Dates of employment:
Years in this line of work:
Title or position:
Supervisor’s name:
Business phone:

Prior employer:
Prior title:
Prior employer’s address:

Prior dates of employment:

Prior employer’s phone:
Estimated income this year:
Actual income last year:
Educational background:
Schools attended:
Dates attended:

Will occupancy be: Full-time Part-time

List the names of ALL proposed occupants (including applicants), and their relationship to applicant(s):

List the names of anyone in the building known to the applicant(s):

Are any pets to be maintained in the apartment? Yes No (Note: If yes, indicate number and kind.)

Has the applicant(s) and/or any occupant(s) ever been convicted of a felony? Yes No (Note: If yes, please explain.)
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

Applicant Co-Applicant
Personal References
1. Name:
Address:

Phone:

2. Name:
Address:

Phone:

3. Name:
Address:

Phone:

Professional/Financial References
1. Name:
Address:

Phone:

2. Name:
Address:

Phone:

3. Name:
Address:

Phone:

Bank & Credit References

Bank Name:
Bank Address:
Account number: Checking Savings Loan
Bank Name:
Bank Address:
Account number: Checking Savings Loan

I agree, as a condition of processing this application, that Cooper Square Realty, Inc. (“Cooper Square Realty, Inc.”) and/or its
employees neither bear nor assume any responsibility whatsoever for the verification or completeness of the Applicant Information.
In addition, I authorize Cooper Square Realty, Inc. to share the Applicant Information, or portions of it, with any other parties they
may reasonably believe necessary to fulfill the purposes of this application. Transfer of the Applicant Information may be made in
any form, including but not limited to mail, overnight courier, facsimile, email or posting on a secure/password protected web site. I
further agree to hold Cooper Square Realty, Inc. harmless from any error or omission in the transfer of the Applicant Information or
from the consequences of the distribution of the Applicant Information to third parties.

X
Applicant Date

X
Co-Applicant (if any) Date
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

Part 2 – Financial Information

Applicant: Co-Applicant:
Address: Address:

Monthly Housing Expenses

Applicant Co-Applicant Total
Income: Applicant Co-Applicant Expenses:
(present) (present) (during lease)
Base monthly salary: Rent:
Overtime (monthly): Maintenance:
Bonuses (monthly): Mortgages/Loan:
Commissions (monthly): Hazard insurance:
Dividends/Interest: Real estate taxes:
Net rental income: Other expenses*:
Other income:
TOTAL: TOTAL:

Assets & Liabilities *Related directly to housing or debt(not personal expenses)

Assets:
Cash (Schedule A):
Contract deposit:
Stocks & bonds (Schedule B):
Investment in business:
Accounts receivable:
Real estate (Schedule C):
Automobiles:
Personal property:
Life insurance(cash value):
Retirement funds/IRA:
401k:
KEOGH:
Profit sharing/pension:
Other assets (Schedule D):
TOTAL:
Applicant Co-Applicant
Applicant Co-Applicant Liabilities
(present) (present)
Notes payable to banks:
Notes payable to relatives:
Notes payable to others:
Install accounts payable:
Automobile:
Other accounts payable:
Mortgages payable:
Unpaid real estate taxes:
Unpaid income taxes:
Chattel mortgages:
Loans on life insurance:
Credit card debt:
Other debts:
TOTAL:

Itemized Schedule of Assets & Liabilities

Schedule A – Cash (attach additional pages if necessary) – Total should match cash line above
Applicant or Co-Applicant Financial Institution Type of account Account Balance

Itemized Schedule of Assets & Liabilities (continued)

Schedule B – Stock, Bonds and Mutual Funds (attach additional pages if necessary) – Total Should match Stocks & Bonds Line
Above
Amount of shares Description Marketable value Non-marketable value
 Cooper Square Realty, Inc.
6 East 43rd Street · New York, NY 10017-4609
Phone: 212-634-8900 · Fax: 212-634-3946

Itemized Schedule of Assets & Liabilities (continued)

Schedule C – Real Estate (attach additional pages if necessary)
Applicant or Property Address Type of Property Amount of Mortgage Insurance main, tax &
Co-applicant Mortgage/liens Payment misc.

Itemized Schedule of Assets & Liabilities (continued)

Schedule D – Other Assets (attach additional pages if necessary)

Explanation:

IF YOU ARE A PRINCIPAL OF OR ARE EMPLOYED BY A FAMILY BUSINESS, PLEASE COMEPLETE THIS SECTION:
Applicant Co-Applicant
Dividend or partnership income (present year)
Dividend or partnership income (prior year)
Dividend or partnership income (second prior year)

DECLARIATIONS
Are there any outstanding judgments against you?
Have you been declared bankrupt in the past 7 years?
Have you had a property foreclosed upon or given title or deed in lieu thereof in the past
7 years?
Are you a party to a lawsuit?
Have you directly or indirectly been obligated on any loan that resulted in foreclosure,
transfer or title in lieu of foreclosure or judgment?
Are you presently delinquent or in default on any Federal debt or any other loan,
mortgage, financial obligation, bond or loan guarantee?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any part of the down payment borrowed?
Are you a co-maker or endorser on a note?
Do you intend to occupy the property as your primary residence?
Have you had ownership interest in a property in the last 3 years?
If yes, what type of property did you own?
How did you hold title to the property?

The foregoing application has been carefully prepared, and the undersigned hereby solemnly declare(s) and certify(s) that all
information contained herein is true and correct. The information is submitted as being a true and accurate statement of the financial
condition of the undersigned on the __________ day of ______________, 20___.

X
Applicant Date

X
Co-Applicant (if any) Date
 NOTICE OF INTENT OF LEASE

Board of Managers
The Fitzgerald Condominium
c/o Cooper Square Realty
6 East 43rd Street
New York, NY 10017

RE: The Fitzgerald Condominium

201 West 74th Street
Apartment _______

Dear Sirs:

This letter will serve as formal notice of the undersigned unit owner’s intention to lease
the above referenced apartment. In accordance with the By-Laws, the following
information is being submitted for your consideration.

Name of Proposed Tenant(s):

Current Resident Address:

Monthly Rent: $

Lease Term Commencing: Ending:

In addition, the undersigned will provide you with such other information as you may
reasonably request.

Sincerely,

BY:
Unit Owner

BY:
Unit Owner
The Board of Managers
The Fitzgerald Condominium
Cooper Square Realty
6 East 43rd Street
New York, NY 10017

RE: Apartment
The Fitzgerald Condominium
201 West 74th Street
New York, NY

I understand and agree that I am responsible for any and all damage done to the building
by myself and/or any person helping me or in my employ to move my belongings into the
building.

I agree that on the day of my move, I will meet with the building’s superintendent and
walk through the building to inspect the condition of lobby, elevator, and hallway.

In addition, at the end of the day when the move-in has been completed, I will notify the
building’s superintendent so that we can inspect the premises to insure that the building’s
condition has not been changed from my move.

Acknowledge and agreed to:

Applicant

Co-Applicant

Dated:
The Board of Managers
The Fitzgerald Condominium
Cooper Square Realty
6 East 43rd Street
New York, NY 10017

RE: Apartment_________
The Fitzgerald Condominium
201 West 74th Street
New York, NY

I understand and agree that no move-in to this apartment will be allowed until the
Managing Agent receives the following documents:

- Notification Letter and/or recorded Unit Owner Power of Attorney.

- Certificate of Insurance as outlined in sales application.

Acknowledged and agreed to:

Applicant

Co-Applicant

Dated:
 NOTIFICATION OF LEGAL MAILING ADDRESS FOR UNIT OWNER

Unit# _____________

All communications and invoices concerning the ownership of Unit _______ should be
sent to the following address rather than to the apartment.

Name: _______________________________________________________________________________________

Address: _____________________________________________________________________________________

Telephone (home): _____________________________ (office) ____________________________________

Mobile: _________________________________________ E-mail: ____________________________________

 6 East 43rd Street • 14th Floor • New York, New York 10017 • 212-682-7373 • Fax: 212-682-5441

House Rules & Regulations Acknowledgement Form

Apartment# _________

Building: ____________________________________

I (We) have read the rules and regulations for the referenced property and hereby agree
to abide by said rules and regulations.

___________________________________ _______________________________
Purchaser/Lessee (Signature) Date

___________________________________ _______________________________
Purchaser/Lessee (Signature) Date
 Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards

Lead Warning Statement

Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can pose
health hazards if not managed properly. Lead exposure is especially harmful to young children and preg-
nant women. Before renting pre-1978 housing, lessors must disclose the presence of known lead-based
paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally approved
pamphlet on lead poisoning prevention.

Lessor’s Disclosure.
(a) Presence of lead-based paint and/or lead-based paint hazards (Check (i) or (ii) below):
(i) _____ Known lead-based paint and/or lead-based paint hazards are present in the housing (explain).
____________________________________________________________________________
(ii)_____ Lessor has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
(b) Records and reports available to lessor (Check (i) or (ii) below):
(i) _____ Lessor has provided the Lessee with all available records and reports pertaining to lead-based paint
and/or lead-based paint hazards in the housing (list documents below).
____________________________________________________________________________
(ii) _____ Lessor has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in
the housing.

Lessee’s Acknowledgment (initial)

(c) _____ Lessee has received copies of all information listed above.
(d) _____ Lessee has received the pamphlet Protect Your Family from Lead In Your Home.

Agent’s Acknowledgment (initial)

(e) _____ Agent has informed the lessor of the lessor’s obligations under 42 U.S.C. 4852d and is aware of
his/her responsibility to ensure compliance.

Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.

________________ ________________ ________________ ________________

Lessor Date Lessor Date

________________ ________________ ________________ ________________

Lessee Date Lessee Date

________________ ________________ ________________ ________________

Agent Date Agent Date

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