Rent Security Complaint Form
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2OFFICE OF THE ATTORNEY GENERAL ERIC T. SCHNEIDERMAN
STATE OF NEW YORK DEPARTMENT OF LAW
RENT SECURITY COMPLAINT FORM
Consumer Frauds and Protection Bureau
Consumer Hotline
120 Broadway, 3rd Floor
TDD (800) 788-9898
New York, NY 10271
Phone: (212) 416-8300 Fax: (212) 416-8787
(800) 771-7755
The Attorney General investigates complaints that a landlord has failed to place security deposits in trust accounts or to pay interest on rent
security deposits. We also try to assist tenants who complain that a landlord failed to return the rent security when the tenant moved out. If,
however, the landlord refuses to return your security deposit because your landlord says that you failed to pay rent or damaged the apartment,
you must generally go to Small Claims Court to resolve the dispute. Before forwarding this complaint to our office, you must attempt to resolve
the matter with your landlord.
Please complete this form only if your attempt to resolve your complaint with the landlord has been unsuccessful. Each tenant should submit
a separate complaint form. You may duplicate this form or obtain additional copies from our office.
Be sure to attach a copy (NOT THE ORIGINAL) of your lease, receipt or other evidence that you paid a security deposit and any other pertinent
letters or documents.
PLEASE PRINT
1. YOUR NAME:
ADDRESS (CURRENT)
Street No.
Apt. No.
City
State
Zip Code
TELEPHONE: HOME
BUSINESS
ADDRESS OF APARTMENT INVOLVED, IF DIFFERENT FROM CURRENT ADDRESS:
Apt. No.
Street No.
City
State
Zip Code
2. FORMER OR CURRENT LANDLORD
INVOLVED IN THIS COMPLAINT:
ADDRESS
TEL.:
Street No.
City
State
Zip Code
3. MANAGING AGENT'S NAME:
ADDRESS:
TEL.:
Street No.
City
State
Zip Code
4. APPROXIMATE NUMBER OF APARTMENTS IN BUILDING:
5. YOUR COMPLAINT CONCERNS:
( )
Landlord failed to return rent security deposit.
( )
Landlord failed to place security deposits in trust account.
( )
Landlord failed to pay interest on security deposit.
6.
(a) AMOUNT OF SECURITY DEPOSIT AND DATE PAID: $
Date:
(b) MOST RECENT MONTHLY RENT: $
CFB003NYC - (rev. 10/12)
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