Fill and Sign the Third Party Notification for Real Property Taxes Application Form

FINANCE NEW lYORK NEW YORK CITY DEPARTMENT OF FINANCE PROPERTY DIVISION SENIOR CITIZEN PROPER TY TAX EXEMPTION APPLICATION B ____ B ________ L ____ APARTMENT #: __________ BC: _________ TC: _______ OWNER'S NAME: ______________________ OFFICE USE ONLY ELIGIBILITY REQUIREMENTS THE FOLLOWING IS INTENDED TO SERVE ONLY AS A GUIDE IN DETERMINING YOUR ELIGIBILITY FOR AN EXEMPTION. ALL SUBMITTED APPLICATIONS ARE SUB- JECT TO REVIEW IN ACCORDANCE WITH SECTION 467 OF THE NYS REAL PROPERTY TAX LAW. uIf you are the sole owner, you must be 65 or older on or before December 31 of the year in which benefits will begin. uIf you and your spouse are co-owners, only one of you must be 65 or older during the calendar year. uIf the co-owners are brother and sister, only one of you must be 65 during the calendar year.uIf the co-owners are tenants-in-common or are joint ten- ants all must be 65 during the calendar year. uThe applicant(s) must live in the house, apartment or unit. u The property must be either a 1-, 2- or 3-family home, co-op apartment or condominium unit. If commercial space exists, then only the residential portion may qualify for an exemption. uOwner must have held title to the property for at least 12 consecutive months prior to March 15 of the year when the exemption goes into effect. There are some limited excep- tions to the 12-month rule. To hear a recorded list of these exceptions, please call Citytax Dial at (718) 935-6736, mes- sage 440. u Combined total income for all owners from all sources must be less than $27,900*, including Social Security Income and exclusive of lossesand allowing for a deduction of docu- mented medical and/or prescription expenses not reimbursed or not paid for by insurance. uIf the property has a 421a, 421b or 421g exemption, you are not eligible for this exemption unless you sign an offi- cial waiver of the 421a, 421b or 421g exemption. NOTE: Cooperative shareholders living in Mitchell-Lama hous- ing, or in housing accommodations provided by Limited Dividend Housing, Redevelopment, or Housing Development Fund Companies, or living in the New York City Department of Housing Preservation and DevelopmentÕs (HPD) Division of Alternative Management Program Housing (Articles II, IV, V and XI of the NYS Private Housing Finance Law), who are aged 62 years or older, with an annual family income below $20,000 are eligible for benefits under the Senior Citizen Rent Increase Exemption (SCRIE) program only. For more information, call HPD at (212) 863-8494. Shareholders living in a cooperative housing which was, or continues to be subject to a mortgage insured, or initially insured by the federal government under Section 213 of the National Housing Act (Section 213 housing) may be eligible for either SCRIE or senior citizen property tax benefits, but not both. NOTE: Eligibility for the SCHE benefit automatically confers eligibility for the enhanced STAR benefit. Enhanced STAR renewal forms will not be mailed to holders of the SCHE bene- fit. * Income threshold subject to change. Dear Taxpayer: The NYC Department of Finance is pleased to offer a reduction in real estate taxes to property owners, aged 65 years or older, with an annual income below $27,900, and who own and reside in one-, two-, or three-family homes, condominium units, or cooperative apartments. Eligible property owners may apply for the exemption between July 15 and March 15 in order to qualify for benefits that are reflected in their annual real estate tax bill. Exemption applications may be filed by mail, or in person with the Assessment Office in the borough where your prop- erty is located. For more details about this program, please read the eligibility requirements and instructions provided below. As a special customer service, an application to des- ignate an adult third party to receive copies of your real estate tax bills and notices of unpaid taxes is conveniently attached to this exemption application. There is no charge for this service, and there are no financial risks for any per- son who agrees to be a third party designee. Applications can be filed at any time during the year with the agencyÕs Central Registration Unit. Enrollment in the third party billing program is optional. Sincerely yours, Rudolph W. Giuliani Mayor Senior Citizen Property Tax Exemption Application Page 2 SECTION 1 - OWNERSHIP/PERSONAL INFORMATION Question 1 - OWNER(S) OF PROPERTY List all owners appearing on the deed/proprietary lease and living spouses, Social Security Numbers and dates of birth. (Attach a separate sheet, if necessary.) Question 4 - PERSONAL STATUS Check the box that applies to the applicant's legal status. If any applicant is married, widowed, legally separated or divorced, attach proof of legal status, such as a copy of a marriage certificate, death certificate, separation decree or divorce settlement. Question 5 - DEED/PROPRIETARY LEASE STATUS Check the box that describes the deed/proprietary lease status. Joint tenants refers to joint ownership with the right to automatic succession to the title upon death of one owner. Tenants in Common refers to ownership by 2 or more persons each of whom has an undivided fractional inter- est in the whole of the property without the right to sur-vivorship. Life Estate refers to a title held during the term of the owner's life and which terminates upon death. Trust refers to a relationship in which an independent party (trustee) holds legal title to property for the benefi- ciaries of the trust who hold the equitable title during the life of the trust. SECTION 2 - INCOME STATEMENT FOR THE LAST CALENDAR YEAR If you attach a copy of your federal return, you do not have to complete this section unless either of the follow- ing is true: 1) you did not itemize medical and prescrip- tion expenses which you wish to claim for this exemption; 2) you are a recipient of a Veterans Administration disabil- ity pension which is excluded from the definition of income for this exemption. Income is the combined income of all owners. If either the husband or the wife has title, include the combined income of both spouses. Income includes, but is not lim- CHECKLIST BEFORE SUBMITTING YOUR APPLICA TION Avoid a delay in the processing of your application. Check (3) to make sure that you do the following before submitting your application to the Property Division: qRead the requirements to make sure you are eligible qFile this application between July 15 and March 15 only qComplete the application in its entirety qHave all property owners and spouses of owners applying for the exemption sign the application qHave a non-relative witness the signatures qList a telephone number where you can be reached and the name and daytime telephone number of a relative or friend qCooperative apartment owners, have an officer of the co-op board complete the certification, Section 4, on page 6 Attach the following: qCopy of most recent deed, (recorded or unrecorded) or if co-op owner, you must submit copy of the page(s) of your proprietary lease, which shows the names of the grantor and grantee and the number of shares in your unit. If a proprietary lease is unavailable, you must submit a copy of your stock certificate, (front and back), showing the names of all owners.qProof of age of owner(s), such as: ucopy of birth certificate (if applicant's name is different from that on birth certificate, also attach proof of name change); ucopy of driver's license; ucopy of passport. qCopy of death certificate, when one of the individuals listed on the deed/proprietary lease is deceased. qCopy of marriage certificate. qProof of income for the last calendar year prior to applying, such as: ucopy of complete and signed federal income tax return for the preceding calendar year, including all schedules; uSocial Security statement; upension fund statement; uIRA distribution. qCopies of bills, receipts and insurance company statements fully documenting your claimed deductions for unreim- bursed medical and/or unreimbursed prescription expenses not reimbursed, or not paid for by insurance, including charges not covered due to a deductible provision of your insurance coverage, for the last calendar year prior to applying. SPECIFIC INSTRUCTIONS ited to, Social Security and retirement benefits, interest, dividends, IRA distributions, net rental income, salary or earnings and net income from self-employment. Income also includes all monies received from any foreign hold- ings, including but not limited to securities, interest from bank accounts, sale of real estate and income from busi- nesses. Do not include VeteranÕs Administration disability pension benefits or gifts and inheritances or money earned through employment in the federal Foster Grandparent Program. SECTION 3 - INCOME-PRODUCING PROPERTY If part of your residence is rented or if you own other income-producing property, complete this section or attach a copy of Schedule E, Supplemental Income & Loss from your federal tax return. On page 6, question 3, enter the whole dollar amount of the gross income from the property and the various expenses for the entire building. If you have more than one rental property, attach a separate Income and Expense Statement. On the line for major repairs, include items such as roofing, windows, plumbing and electric wiring. RENEWAL If your exemption is approved, annual applications are not necessary as long as the renewal notice (to be sent to you by mail) is completed and returned by the closing date. Renewal notices are sent every other year. CHANGE OF OWNERSHIP You must notify the Borough Assessment Office in writ- ing of any change in the ownership. If available, you should also include the name of the party to whom the property was sold and their telephone number.WHEN AND WHERE TO FILE You must file this application with all required documents between July 15 and March 15. If filing by mail, the appli- cation must be postmarked by March 15. Mail or bring your application to the Assessment Office in the borough in which the property is located. The addresses are listed below. MANHATTAN Municipal Building One Centre Street , Rm. 910 New York, NY 10007 BROOKLYN Municipal Building 210 Joralemon Street Room 200 Brooklyn, NY 11201 BRONX 1932 Arthur Avenue Room 701 Bronx, NY 10457 QUEENS 144-06 94th Avenue 2nd Floor Jamaica, NY 11435 STATEN ISLAND 350 St. Marks Place Staten Island, NY 10301 The Department of Finance is pleased to offer the following customer service initiative to provide an applicant with proof of filing. Upon receipt of an application, the department will time-stamp a copy of the application. Please note that the department can only provide this service when a copy is provided by the applicant. Where an applica- tion has been mailed, a self-addr essed stamped envelope must also be provided in addition to the copy. All applicants are strongly encouraged to retain for their per- sonal records a copy of all applications, documents and renewal forms that are submitted to department offices. Senior Citizen Property Tax Exemption Application Page 3 NEED HELP? If you need help in completing this form, visit any of the borough offices listed above or call: MANHATTAN .....................................(212) 669-4896 BROOKLYN .............................. (718) 802-3560 BRONX ..............................................(718) 579-6879 QUEENS.................................. (718) 298-7099 STATEN ISLAND ..............................(718) 390-5295 SECTION 1 - OWNERSHIP / PERSONAL INFORMATION 1.Borough: _____________________________ Block: ______________________ Lot: ________________ Address of Property: ____________________________________________________________ Zip Code: __________________ 2.Type of residence (check one): q 1-, 2-, 3-FAMILY HOME q CONDOMINIUM UNIT q COOPERATIVE APARTMENT - unit number: ___________ 3. Applicant/Owner Social Security Date of Daytime Phone Name and Daytime Phone Name Number Birth Number Number of Relative or Friend a. ____________________ _________________ _______ _____________ _________________ b. ____________________ _________________ _______ _____________ _________________ c. ____________________ _________________ _______ _____________ _________________ 4.Personal status (check one) (Attach proof of status) (see instructions) : q SINGLE (includes divorced, unremarried widow or widower) q LEGALLY SEPARATED q MARRIED 5.Deed/proprietary lease status (check one) (see instructions for definitions) : q INDIVIDUAL q HUSBAND/WIFE q JOINT TENANTS q TRUST (Must submit copy of Trust Agreement) q TENANTS IN COMMON q LIFE ESTATE q SIBLINGS 6.Is the address the legal and primary residence of all of the owners?...................................q YES q NO 7.Is any owner now in a nursing home or institution?..........................................................q YES q NO If " YES ", state owner's name: _____________________________________ Date entered: _______________ 8. Is any person whose name appears on the deed/proprietary lease deceased?........................... q YES q NO If " YES ", list name of deceased and attach a photocopy of the death certificate or other proof of death. ________________________________________________________________________________________ 9a.Does the present deed/proprietary lease to the property indicate ownership of less than 12 months? .................................................................................................................q YES q NO 9b. If " YES ", indicate address of previous property: __________________________________________________ _________________________________ Date of purchase: ______________ Date of sale: _____________ 10a.Is any other property owned by the applicants? (If " YES ", you must complete Section 3.).....q YES q NO 10b.Is your residence partially rented? (If " YES ", you must complete Section 3.)......................q YES q NO 11.Is the entire property, listed in item 1 above, used exclusively for residential purposes? .........q YES q NO If " NO ", explain use - Indicate percentage nonresidential: ___________________________________________ _______________________________________________________________________________________ Senior Citizen Property Tax Exemption Application Page 4 OFFICE USE ONLY Approved ............... q Denied ............. q Reason: _______________________ Reviewer: ______________ Date :___________ SECTION 2 - INCOME STATEMENT Senior Citizen Property Tax Exemption Application Page 5 1.Did any owner have to file a federal income tax return for the last calendar year? ....................q YES q NO If " YES ", YOU MUST ATTACH A COMPLETE COPY OF THE TAX RETURN INCLUDING ALL SUPPLEMENTARY SCHEDULES. 2. Complete the income statement if any of the following is true: 1) at least one owner of the property did not file a federal income tax return for the last calendar year; or 2) you did not itemize medical and prescription expenses on the federal income tax return which you wish to claim as a deduction against income for this exemption; or 3) you are recipient of a Veterans Administration disability pension which is excluded from the definition of income for this exemption. State totalincome of each applicant. If more space is required, attach an additional statement. ALL INCOME IS SUBJECT TO VERIFICATION. 3. I ncome Source for Calendar Year 19____Household Income Amount A - Applicant B - Spouse C - Other Applicant a. Social Security (must attach FSA 1099 statement) .................. b. Salary or wages, including part-time employment .................. c. Interest .................................................................................. d. IRA Distribution (DO NOT INCLUDE ROLLOVERS).................. e. Nontaxable interest on state or local bonds ............................ f. Dividends................................................................................. g. Net income of property (from page 6, Section 3) ....................... h. Capital gains ........................................................................... i. Gains from sales or exchanges ............................................... j. Net earnings from business or profession .............................. k. Net income from estates or trusts .......................................... l. Government or private retirement or pension plan payments .. m. Alimony or support money ..................................................... n. Disability payments (DO NOT INCLUDE VETERANS ADMINISTRATION DISABILITY PENSION) .............................. o. Workers compensation ........................................................... p. Foreign holdings (REFER TO DEFINITION PROVIDED FOR ON PAGE 3 IN SECTION 2 AND SPECIFY:___________________ q. Other (specify: __________________________________ ) .. r. TOTAL (add lines a through q) ................................................ 4. If any of the applicants have unreimbursed medical and/or unreimbursed prescription drug expenses for the above calendar year, including charges not covered due to a deductible provision of your insurance coverage, enter the total of such expenses for each applicant in the appropriate column below. ATTACH COPIES OF BILLS, RECEIPTS AND STATEMENTS FROM THE APPLICANT'S INSURANCE CARRIER(S) WHICH DOCUMENT THE TOTAL UNREIM- BURSED MEDICAL AND/OR PRESCRIPTION DRUG EXPENSES CLAIMED. Unreimbursed medical/prescription expenses A - Applicant B - Spouse C - Other Applicant a. Medical Expenses: ................................................................... b. Prescription Expenses: ............................................................ c. Medical Insurance Premiums ................................................... d. Total Expenses: ....................................................................... 5. Adjusted Income Total a. Subtract Line 4d for each applicant from 3r above . This is your total adjusted income. If no deductions are claimed, carry down total from Line 3r ................................................... TOTAL HOUSEHOLD INCOME (ADD LINE 5A OF COLUMNS A, B AND C) SECTION 4 - CERTIFICATION BY COOP BOARD OF MANAGERS SECTION 3 - INCOME-PRODUCING PROPERTY Senior Citizen Property Tax Exemption Application Page 6 I certify that all statements made on this application are true and correct to the best of my belief. I understand that any willful false statement of material fact will be grounds for disqualification from future exemption for a period of five years and a fine of not more than $100. ___________________________________ ___________________________________ _________________ ___________________________________ ___________________________________ _________________ ___________________________________ ___________________________________ _________________ Signatures of all applicants s Non-relative witness s Date s Complete this section if you rent any part of your residence or own income-producing property. ALL PERSONS FILING A FEDERAL TAX RETURN MUST ATTACH A COPY OF SCHEDULE E, SUPPLEMENTAL INCOME AND LOSS. 1.Is the income-producing property the same as the owner's residence? ........................q YES q NO 2.If the answer to 1 is " NO ", list the address of the income-producing property: ___________________________ ________________________________________________________________________________________ 3.Complete the following Income and Expense Statement. Attach a separateIncome and Expense Statement for each rental property. If you attach a copy of your federal Schedule E, IRS form detailing Supplemental Income and Loss, you do not have to complete the schedule below. a.GROSS INCOME ...........................................a. b.EXPENSES FOR ENTIRE BUILDING Real estate taxes ............................................... _______________________ _____________________ Mortgage interest ............................................... _______________________ _____________________ Water and sewer charges .................................. _______________________ _____________________ Heating fuel (if provided to tenants) ................... _______________________ _____________________ Electric (if provided to tenants) ......................... _______________________ _____________________ Insurance .......................................................... _______________________ _____________________ Major repairs .................................................... _______________________ _____________________ Painting / cleaning / maintenance ..................... _______________________ _____________________ Other specify :___________________________ _______________________ _____________________ TOTAL EXPENSES ..............................................b. tOFFICE USE ONLY t NET INCOME OF PROPERTY CERTIFICATION and SIGNATURE For Cooperative properties only - The following information must be completed by an officer of the cooperative corporation: Applicant's unit number: ___________ Floor number of this unit: ___________ Monthly maintenance charge for this unit: $ ____________________ Number of shares in this unit owned by applicant: ____________ Date applicant purchased these shares: _______ / _______ / _______ Borough: ______________________ Block: ______________ Lot: ____________ of the building in which this unit is located. Total number of shares for this development: _________________________ I certify that the above information is true and correct. ( ) ____________________________________ ________________________________ ______________ ________________ Signature of Officer print name Title Telephone number Sen. Cit. Prop. Tax Exempt. Appl. Rev. 07/99 FINANCE NEW lYORK NEW YORK CITY DEPARTMENT OF FINANCE THIRD PAR TY NOTIFICATION FOR REAL PROPER TY TAXES APPLICATION Under state law, senior citizens and disabled home- owners may designate an adult third par ty to receive copies of real estate tax bills and notices of unpaid taxes. The law's intent is to help these taxpayers avoid losing their homes for nonpayment of taxes. WHO IS ELIGIBLE? Owner-occupants of 1-, 2-, or 3-family residential real proper ty who are either: (a) at least 65 years of age, or (b) disabled by a physical or mental impairment which substantially limits one or more of their major life activities. WHEN MUST I APPLY? You can apply any time during the year, but allow 60 days for the application to be processed. However, if you would like a third par ty to receive a copy of the July 1st Real Estate Tax bill which is often mailed out in June, please make cer tain to file your application by April 1. WHOM MAY I CHOOSE AS MY THIRD PARTY? Any adult who consents to your designation, such as a friend or a relative. HOW DOES A THIRD PARTY DESIGNEE SHOW CONSENT? By signing your application form in the appropriate blank. MUST I APPLY EACH YEAR? No. Once you apply, the duplicate notices will be sent to your designee unless you advise the Central Registration Unit (25 Elm Place, 3rd Floor, Brooklyn, NY 11201) that the practice should stop. HOW DO I APPLY? Complete For m EA-923 (Request for Mailing of Duplicate Tax Bills or Statements of Unpaid Taxes to a Third Par ty) and mail it to the following address. New York City Depar tment of Finance Central Registration Unit 25 Elm Place, 3rd Floor Brooklyn, NY 11201 ARE THERE FINANCIAL RISKS INVOLVED IN AGREEING TO BE A THIRD PARTY DESIGNEE? No. Both the law and the form of the duplicate tax bill and notice include a statement advising the third par ty that he or she is under no legal obligation with respect to the bill or notice. Dear Taxpayer: If you are a senior citizen, aged 65 years or older, or if you suffer from a physical or developmental disability, you may designate an adult third party to receive copies of your real estate tax bills and notices of unpaid taxes. The New York City Department of Finance is pleased to offer the benefits of the third party notification pro- gram to eligible taxpayers free of charge by authority of state law. Although you can apply any time during the year, you must allow at least 60 days for the appli- cation to be processed. In order to request that dupli- cate tax bills and statements of unpaid taxes be mailed to third party designees in time for the July 1st real estate tax billing period, eligible property owners must file a completed application by preceeding April 1st. For more details, please refer to the eligibility require- ments and follow the application instructions provided below. Sincerely yours, Rudolph W. Giuliani Mayor FORM EA-923 CLIP AND RETURN TO NEW YORK CITY DEPARTMENT OF FINANCE, CENTRAL REGISTRATION UNIT, 25 ELM PLACE, 3RD FL., BROOKLYN, NY 11201 SECTION 1 - TAXPAYER INFORMATION Taxpayer Name ______________________________________________ Mailing Address ______________________________________________ City & State ___________________________ Zip Code _____________ Proper ty Identification (as shown on assessment roll) _____________ ____________________________________________________________ Tax Billing Address (if dif ferent than mailing address) _____________ ____________________________________________________________ ___________________________________ _____________________ Signature DateThe Applicant is (check one): q At least 65 years of age OR q Disabled Third Party Notification for Real Property Taxes Application REQUEST FOR MAILING OF DUPLICATE TAX BILLS OR STATEMENTS OF UNPAID TAXES TO A THIRD PAR TY I request that a duplicate of any tax bill or statement of unpaid taxes with respect to my proper ty as described below be mailed to the person whom I have designated. In making this request, I understand that neither the tax collecting of ficer nor any other local government employee has any liability if for any reason the duplicate is not mailed to or not received by my designee. SECTION 3 - PHYSICIANÕS CERTIFICATION OF PHYSICAL OR MENTAL DISABILITY Taxpayer Name: _____________________________________________________________________________________________________________ Office Address: _____________________________________________________________________________________________________________ NYS License Number ____________________________________________________ Date of Issue ___________________________________ PatientÕs Name ______________________________________________________________________________________________________________ PatientÕs Address ____________________________________________________________________________________________________________ Does patient have a physical or mental impairment which substantially limits one or more major life activities (e.g., walking)? ........................................................................................... q YES q NO I certify that all statements made in this section are true and correct to the best of my knowledge and professional belief. ______________________________________________________________ ____________________________________ Signature of PhysicianDate SECTION 2 - THIRD PARTY DESIGNEE Third Par ty Name ____________________________________________ Mailing Address _____________________________________________ City & State __________________________ Zip Code ____________ Telephone __________________________________________________ ___________________________________ ____________________ Signature Date