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Get NY OTDA LDSS-3668 2010

_________________________________ Does the tenant pay to you an amount, separate from the rent, for other non-heating utilities? Yes No If yes, list monthly amount: _________________________________________________ If tenant pays for non-heating utilities, are there separate meters for the tenant’s apartment? Yes No To your knowledge, does anyone that lives outside of the household pay all or part of the rent and/or utilities? Yes No If yes, please explain: ____________________________________.

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