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Holdover Eviction Submission Form

Please Note: Due to time constraints, any Notice of Termination submissions/requests after the 25th of the month will not be processed until the following month.

Deeded Property Owner(s) *

Special Notes

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 is 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

All Occupants Name(s) *

First

Last

Tenant Names

First

Last

Tenant Names

First

Last

Type of Lease *

Oral Lease
Written Lease

Duration of Written Lease *

Month-to-Month
One-Year or More
Not Applicable

Section 8 Assistance? *

Yes
No

Tenancy Start Date *

Monthly Rent Amount *

Have you applied for and/or received Rent Relief, ERAP or LRAP for this Tenant? *

Yes
No
Unsure

Special Notes:

Contact Info for Party Submitting Form: *

First

Last

Company

E-Mail Address *

Telephone Number *