Form Rp-524 - Complaint On Real Property Assessment Page 4
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4RP-524 (03/09)
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PART FOUR: DESIGNATION OF REPRESENTATIVE TO MAKE COMPLAINT
I,
,
as complainant (or officer thereof) hereby
designate
to act as my representative in any and all
proceedings before the board of assessment review of the city/town/village/county of
for
purposes of reviewing the assessment of my real property as it appears on the
(year) tentative assessment
roll of such assessing unit.
Date
Signature of owner (or officer thereof)
PART FIVE: CERTIFICATION
I certify that all statements made on this application are true and correct to be best of my knowledge and belief, and I
understand that the making of any willful false statement of material fact herein will subject me to the provisions of
the Penal Law relevant to the making and filing of false instruments.
Date
Signature of owner (or representative)
PART SIX: STIPULATION
The complainant (or complainant’s representative) and assessor (or assessor designated by a majority of the board of
assessors) whose signatures appear below stipulate that the following assessed value is to be applied to the above
described property on the
(year) assessment roll: Land $
Total $
(Check box if stipulation approves exemption indicated in Part Three, section B.2. or C.1.)
Complainant or representative
Assessor
Date
SPACE BELOW FOR USE OF BOARD OF ASSESSMENT REVIEW
Disposition
Clear Form
Unequal assessment
Excessive assessment
Unlawful assessment
Misclassification
Ratification of stipulated assessment
No change in assessment
Reason: _____________________________________________________________________________________
____________________________________________________________________________________________
Vote on Complaint
All concur
All concur except: _______________________
against
abstain
absent
Name
_______________________
against
abstain
absent
Name
Decision by
Tentative assessment
Claimed assessment
Board of Assessment Review
Total assessment
$________________
$_________________ $_________________________
Transition assessment (if any) ... $________________
$_________________ $_________________________
Exempt amount .......................... $________________
$_________________ $_________________________
Taxable assessment .................... $_________________ $_________________ $_________________________
Class designation and allocation of assessed value (if any):
Homestead ................................ $________________
$_________________ $_________________________
Non-homestead ......................... $________________
$_________________ $__________________________
Date notification mailed to complainant ________________________________
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