NOTICE OF HOMEOWNER ASSOCIATION RESTRICTIVE COVENANTS

This notice is meant to advise the public of the existence of and information about restrictive covenants that prohibit or restrict property owners
from taking certain actions or engaging in certain activities on a property within the control of a homeowners association. Once this notice has
been completed and submitted, it will be recorded in the New York City Department of Finances Automated City Register Information System
(ACRIS) in connection with the property described.
This notice is intended only to provide information and describe restrictive covenants that already exist. It is not to be considered in
any way a declaration of new restrictions.
SECTION I HOMEOWNER ASSOCIATION INFORMATION
Homeowner Association Name: ________________________________________________________________________________________
Homeowner Association Representative: _________________________________________ Title: __________________________________
Business Address: ________________________________________
City: ____________________________

State: _____

Zip: _____________

Telephone No.: _______________________________

SECTION II PROPERTY INFORMATION

Borough: ______________________ Block: _____________ Lot:___________
Street Number & Name: __________________________________________

Unit / Apartment Number: __________

PLEASE ATTACH THE PROPERTYS LEGAL DESCRIPTION

SECTION III RESTRICTIVE COVENANTS
Title of Document Establishing the Restrictive Covenants: ___________________________________________________________________
Where the Document Detailing the Restrictive Covenants is Located (Liber, Reel and Page or CRFN): ________________________________

PLEASE ATTACH A COPY OF THE DOCUMENT THAT ESTABLISHED THE RESTRICTIVE COVENANTS TO THIS NOTICE
SECTION IV CERTIFICATION
I certify that all information contained in this notice and the accompanying documents is true and correct to the best of my knowledge and
belief. I understand that the willful making of any false statement of material fact contained herein will subject me to the provisions of New York
Penal Law 175.30 related to the making and filing of false instruments and will make this notice null and void.
Signature: _____________________________________ Print Name: _________________________________ Date: ___________________
SECTION V - ACKNOWLEDGEMENT
State of New York
)
) ss.:
County of
)
On the _____day of ___________ in the year ________ before me, the undersigned, personally appeared ____________________________,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

____________________________________
Notary Public Signature

____________________________________
Notary Public Office and Title

Notary Public Stamp or Seal: