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I, ________________________________________________ do solemnly swear, that I will support the Constitution of the United States and the Constitution of the State of New York, and that I will faithfully discharge the duties of the office of MEMBER of the Rent Guidelines Board of The City of New York, according to the best of my ability. Subscribed and sworn before me, this ________day of _______________, A. D. 20_____ _________________________________
(Member signature)
(Notary Public signature and stamp)
and filed in the office of the City Clerk, this ______ day of ____________, A. D. 20____. _________________________City Clerk

Written Statement of Eligibility (sample form)

A letter for the Rent Guidelines Board files is traditionally supplied to the Executive Director following appointment, affirming compliance with the eligibility requirements. Here is an example of a typical format for this letter:

Dear ______________________,

(Executive Director) In connection with my appointment to the Rent Guidelines Board, I, _____________________, affirm that I am not a member, officer or employee of any municipal rent regulation agency or the state division of housing and community renewal; I do not own or manage real estate covered by the Rent Stabilization Law; I am not an officer of any owner or tenant organization; and I am a resident of New York City. For Chairs only: In addition, I hold no other public office. ___________________________________

Financial Disclosure form sample page from Conflict of Interest Board (COIB)


sheet for Board members (sample)


Date of Meeting                             

Place of Meeting Board

Members Name                    Signature             Social Security #

EDWARD HOCHMAN___________________________________________________

BARTHOLOMEW CARMODY______________________________________________

VINCENT CASTELLANO________________________________________________

JEFFREY COLEMAN____________________________________________________

HAROLD A. LUBELL____________________________________________________

JUSTIN MACEDONIA___________________________________________________

DAVID PAGAN_________________________________________________________

AGUSTIN RIVERA______________________________________________________
EDWARD WEINSTEIN___________________________________________________

Per Diem requisition form

An Introduction to the NYC Rent Guidelines Board
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