Kaled Management
7001 Brush Hollow Road
Westbury, NY, 11590

Current Occupant
Apartment Number
Property Address
City, State, Zip Code

                                                                                Keep the top part of this form for your records.

Annual Notice to Tenant or Occupant in Buildings with 3 or More Apartments
Protect Your Child from Window Falls and Lead Poisoning
You are required by law to complete and return this form to your landlord before February 15 each year. If you do not return the form, your landlord is required to visit your apartment to find out the ages of children living with you. 
Call 311 for more information on preventing window falls and lead poisoning.	
Window Guards
•	Your landlord is required by law to install window guards in all your windows if a child age 10 years or younger lives with you, or if you ask for them (even if no children live with you). However, windows that open to fire escapes and windows on the first floor used as fire exits should not have window guards. 
•	Window Guards should be installed so there is no space greater than 4 ½ inches above or below the guard, on the side of the guard, or between the bars.
•	It is against the law for you to refuse, interfere with installation, or remove window guards where they are required. 

The above requirements apply to all buildings with 3 or more apartments regardless of when they were built.	Peeling Lead Paint
•	Your landlord is required by law to inspect your apartment for peeling paint and other lead paint hazards at least once a year if a child age 6 years or younger lives with you.
•	Always report peeling paint to your landlord. If a child age 6 years or younger lives with you, your landlord must inspect your apartment.  Your landlord must provide you with the results of these paint inspections.
•	Your landlord must use safe work practices to repair all peeling paint and other lead paint hazards. 
•	If you have a baby or if a child age 6 years or younger comes to live with you during the year, you must notify your landlord in writing.
The above requirements apply to buildings with 3 or more apartments built before 1960, or built between 1960 and 1978 if the landlord knows that lead paint is present in the building. 	
Fill Out and Detach the bottom part of this form and return in envelope.

Please check YES or NO:
1. A child age 10 years or younger lives in my apartment:                                                                    □ YES      □ NO
    IF NO: I want window guards even though no children age 10 years or younger live in my apartment: □ YES      □ NO
    IF YES: A child age 6 years or younger lives in my apartment:                                                         □ YES      □ NO  
2. Window guards are installed in all windows as required:                                                                   □ YES      □ NO
3. Window guards need maintenance or repair:                                                                                   □ YES      □ NO	

Current Occupant							Return to:

Kaled Management
7001 Brush Hollow Road
Westbury, NY, 11590

Apartment Number
Address
City, State, Zip Code

Name of Tenant/Occupant (Print): ______________________________
Tenant/Occupant Signature: ___________________________________
Date: _____________________________________________________