Form DOS-2156, New York State Housing Discrimination Disclosure Form Instructions
This form contains 4 fields organized into 1 section. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Salesperson/Broker Name | Text |
Please enter the printed name of the Real Estate Salesperson or Broker who provided this form.
|
| Real Estate Company Name | Text |
Please enter the printed name of the Real Estate company, firm, or brokerage.
|
| Consumer/Seller/Landlord Name | Text |
Please enter the name of the Real Estate Consumer, Seller, or Landlord acknowledging receipt of the disclosure form.
|
| Acknowledgement Date | Date |
Please enter the date the Real Estate Consumer/Seller/Landlord acknowledged receipt of the disclosure form.
|