Please do not use this form to report the High Rent Vacancy Deregulation ($2,500 or more) of a rent stabilized apartment. Deregulation of a rent stabilized apartment for this reason is to be reported on the Annual Apartment Registration Form by selecting the High Rent Vacancy option on the Exempt Status tab.

Within 30 days following the date of first rental this report shall be filed with the Division of Housing and Community Renewal by delivery or mailing. This report needs to be filed if the apartment was subject to Rent Control prior to the vacancy; it is not to be filed if the apartment was subject to Rent Stabilization prior to the vacancy.
Owner's Report of Vacancy Decontrol For A New York City Apartment Subject To Rent Control:
Tenant Information:
Insert name of current tenant in subject building/apartment.


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Building Information:
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Apartment Information:
* Click to open/close calendar Example: mm/dd/yyyy
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If a lease has been executed for the first tenant, please supply the lease terms:
* Click to open/close calendar Example: mm/dd/yyyy
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Mailing Address of Owner or Managing Agent:
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Mailing Address of Authorized Representative:
Complete only if the Authorized Representative is filing the report and is not listed above.


To Owner and Tenant:
Based solely upon the statement of facts submitted on this report, as filed pursuant to Section 2203.2 of the New York City Rent and Eviction Regulations (CRER), it is the opinion of the Rent Administrator that the described housing accommodations are not subject to rent control. This opinion shall be of no force and effect if any material fact has been omitted or incorrectly stated. Housing accommodations which become vacant on or after June 30, 1971 either by voluntary surrender of possession or eviction pursuant to Part 2204 of the CRER are not subject to rent control. This report may be challenged in an Administrative Determination Proceeding, as filed pursuant to Section 2202.22 of the CRER.