Form RA-23.5 at a glance
What it is: Form RA-23.5 is the Notice To Owner Of Family Members Residing With The Named Tenant In The Apartment Who May Be Entitled To Succession Rights/Protection From Eviction.
Who signs: Sign: Signature(s) of Tenant(s) and Date.
The tenant must provide the owner with the name of any person who has the right to be named as a tenant on a renewal lease, whether or not the owner requests the information.
A filled-in Form RA-23.5 example: a tenant gives notice of a mother who lives with her
How to fill out Form RA-23.5, box by box
Notice Requested by Owner or Notice Submitted by Tenant
Please check the appropriate box: Notice Requested by Owner or Notice Submitted by Tenant.
The information may be requested by owners, or provided by tenants, as follows: (1) by owners of rent stabilized apartments, at any time, but no more often than once in twelve months; (2) by owners of rent controlled apartments, at any time; (3) by tenants of rent stabilized and rent controlled apartments, at any time.
Mailing Address of Tenant and of Owner/Agent
Under Mailing Address of Tenant, enter the Tenant's Name, Number/Street, Apt. No. and City, State, Zip Code.
Under Mailing Address of Owner/Agent, enter the Owner's/Agent's Name, Number/Street and City, State, Zip Code.
Subject Building (if different from tenant's mailing address)
Enter the Subject Building (if different from tenant's mailing address) as Number and Street, Apt. No. and City, State, Zip Code.
Statement of Tenant
Under Statement of Tenant, write the names of persons other than tenant(s) residing in the apartment and the date of commencement of primary residence in the apartment by such persons.
Write the family relationship, if any. If the relationship is not listed under 3 (a)(i) on reverse side, but meets the requirements of 3 (a) (ii), indicate “other family member” or “OFM”.
Check box if such persons are senior citizens and/or disabled persons: Senior Citizen or Disabled Person. See definitions on reverse side of this form.
If there are additional persons, check box and attach separate sheet.
Signature(s) of Tenant(s) and Date
Sign: Signature(s) of Tenant(s) and Date.
More rules for Form RA-23.5
The following information may be requested by owners or provided by tenants: (1) the name of any person(s) other than the named tenant(s) who are residing in the apartment; (2) whether such person is a family member of the tenant and if such person is, or upon the passage of the applicable period of required minimum residency, may become, a person entitled to be named as a tenant on a renewal lease (for rent stabilized apartments), or protection from eviction (for rent controlled apartments), and the date such person commenced primary residence with the tenant; (3) whether such person is a senior citizen or disabled person.
When a tenant provides a completed copy of this form to the owner, the tenant should obtain and keep proof thereof, including a completed copy of the form. The owner should also keep a completed copy of the form. Moreover, an owner may use the information in this form if any later statements are inconsistent with the statements made in this form.
For rent-stabilized and rent-controlled apartments throughout New York State, except where occupancy is restricted by income limitations pursuant to federal, state or local law, regulations or other governmental agency requirements, where a tenant permanently vacates an apartment, any family member of the tenant shall have the right to a renewal lease (rent stabilization), or to protection from eviction (rent control), provided that such family member has resided with the tenant as a primary resident in the apartment for 2 years (1 year for senior citizens or disabled persons) immediately prior to the permanent vacating of the apartment by the tenant, or from the inception of the tenancy or commencement of the relationship, if for less than such periods.
A Family Member is defined as: (i) A spouse, son, daughter, stepson, stepdaughter, father, mother, stepfather, stepmother, brother, sister, grandfather, grandmother, grandson, granddaughter, father-in-law, mother-in-law, son-in-law or daughter-in-law of the tenant (or permanent tenant for New York City rent stabilized hotels). (ii) In addition to such traditional family members, for the purpose of renewal lease and eviction protection rights, a family member also includes those persons (nontraditional family members) who have resided with the tenant, as set forth in item 1 above, in a familial relationship based upon emotional and financial commitment and interdependence with the tenant or permanent tenant.
A Senior Citizen is defined as: A person who is sixty-two years of age or older.
Sources
[1] Form RA-23.5 (10/20), Notice To Owner Of Family Members Residing With The Named Tenant, NYS Division of Housing and Community Renewal (the Official source link on this page).