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Non-Payment Eviction Submission

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Non-Payment Eviction Submission

Deeded Property Owner(s) *

Property Address *

First

Last

Unit and Zipcode

First

Last

Do you have a current Rental Registry or Certificate of Compliance from the City of Syracuse for this property? (Check here: https://ips.egov.basgov.com/syracuse/parcelsearch.aspx) *

Yes
No
N/A (Property not in City of Syracuse)

Access Code or Key Required for Common Area *

Yes - Access Code (Provide door code in Special Notes section)
Yes - Physical Key
No

Provide Access Code Here: *

All Occupant Name(s) (18 years of age and older) *

First

Last

Tenant Names

First

Last

Tenant Names

First

Last

Section 8 Assistance? *

Yes
No

Type of Lease *

Oral Lease
Written Lease

Lease Start Date *

Monthly Rent Amount *

Have you received OCERA, ERAP or LRAP for this Tenant? *

Yes
No
Unsure

Date that OCERA, ERAP or LRAP was received: *

Payments in Arrears *

First

Last

Month 2

First

Last

Month 3

First

Last

Month 4

First

Last

Month 5

First

Last

Month 6

First

Last

Month 7

First

Last

Month 8

First

Last

Month 9

First

Last

Month 10

First

Last

Month 11

First

Last

Month 12

First

Last

Choose One: *

I just want the tenant(s) out, do not make a "Pay to Stay" deal
You may make a "Pay to Stay" deal

Choose One: *

In an effort to speed up the eviction process, I am willing to waive monetary judgment against the Tenant in exchange for an Eviction Warrant
I am not willing to waive judgment against the Tenant

Special Notes:

Contact Info for Party Submitting Form: *

First

Last

Company

E-Mail Address *

Telephone Number *