Nycha 040 505A Form PDF Details

Are you a landlord participating in the New York City Housing Authority (NYCHA) program and need to complete a 040 505A form? Understanding how to fill out this document properly is crucial for both tenants and landlords alike, as it helps ensure that everyone's rights and responsibilities are being met. In this blog post, we will be diving into what exactly is required when completing the NYCHA 040505A form so that all parties involved can rest assured they have performed their statutory obligations correctly. Keep reading to learn more about how this document works!

QuestionAnswer
Form NameNycha 040 505A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescat registration nyc, nycha dog and cat policy, nycha dog registration, pet registration form

Form Preview Example

NYCHA 040.505A (REV. 8/06)

DOG AND CAT VETERINARIAN CERTIFICATION

NEW YORK CITY

HOUSING AUTHORITY

FOR OFFICE USE ONLY

PET TRACKING #

TENANT OF RECORD

STREET ADDRESS

ACCOUNT # (9 digit)

NOTE TO TENANT

After you submit the Dog and Cat Registration form to NYCHA, bring your pet to a veterinarian for examination and ask the veterinarian to complete this form.

You must return the completed form to your management offi ce no later than __________________

(90 days after form is given to tenant).

You will not have to submit a new Veterinarian form again unless you get a new pet. However, you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certificate.

PET DESCRIPTION

PET TYPE

DOG

CAT

PET’S DATE OF BIRTH

BREED

 

 

DESCRIPTION (e.g., color, markings)

CURRENT WEIGHT

EXPECTED WEIGHT WHEN FULLY-GROWN

LBS.

LBS.

 

 

 

HEALTH REQUIREMENTS

 

 

 

 

 

 

NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE

 

 

 

DOG LICENSE NUMBER

 

(A dog must be licensed and must wear its license tag when in public)

 

 

 

 

 

 

SPAYED OR NEUTERED

 

 

NO

YES

(Dogs and cats must be spayed or neutered)

RABIES VACCINATION CURRENT

NO

YES – TAG #

 

(Dogs and cats must have a current rabies vaccination)

VETERINARIAN CERTIFICATION

I, the undersigned veterinarian, examined the above described pet and certify that the information given is accurate.

NAME OF VETERINARIAN

PROFESSIONAL LICENSE #

BUSINESS ADDRESS

 

TELEPHONE # (

)

SIGNATURE

 

DATE

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