Rf1 - Refund Request Application - New York
Download a blank fillable Rf1 - Refund Request Application - New York in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Rf1 - Refund Request Application - New York with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1NEW YORK CITY DEPARTMENT OF BUILDINGS
RF1 - REFUND REQUEST APPLICATION
Form must be type written
Please read the instructions for important information before completing this form.
1
Applicant Information:
Request Date:
(Print Name)
(Phone #)
(E-Mail Address)
2
Account Information:
Transaction Date (mm/dd/yy):
Invoice#/Online Transaction ID#
Order#
Application/Job #
The application status is a factor in determining the refund amount.
(If applicable)
Select One
Borough or Unit:
Block:
Lot:
3
Reason For refund Request:
Check the appropriate box below and attach additional documentation if necessary.
Fee Exempt (FE)
ECB Dismissal (ECB)
Overpayment (OP)
Bona Fide/New Owner (BFP)
Duplicate Payment (DUP)
Application Withdrawn (AW)
Duplicate Filing (DF)
Other (Attach Justification)
4
Payment Information:
Attach Supporting Documentation
Check the appropriate box and specify dollar amount:
Credit Card
Cash
Check/Money Order/e-Check
a)
Amount Paid:$ _______________
Full Filing Fee
Partial Filing Fee
b)
Correct Fee: $ ________________
c)
0
Request Amount: $ _____________ (A minus B)
If payment was made by check or money order a copy of the front and back of the cancelled check or money order
and all supporting documentation must be submitted with this application to the Borough Office or Central Unit where
payment was made. If payment was made by credit card a copy of the credit card receipt is required
5
Refund Check Information:
Approved refunds are issued to the maker of the check only, the maker is the person who issues and signs the check.
I hearby affirm that I am entitled to a refund for the reason claimed above. Any documents submitted in support of claim are unaltered
Name:
Signature:
Street Address
Apt/Floor
City
State
Zip Code
I am the owner of the property
I am the filing representative for the owner
I am an officer of the cooperative management board
I am a member of the condominium management board
I am the attorney/legal representative for the owner
Other: Explain the nature of your relationship to the property owner
6
Internal Use Only-Borough Office:
Received Date:_______________
Appl Status
Approve
Disapprove
Check box if copies of check is submitted:
If a copy of the check is not submitted DO NOT FORWARD THE APPLICATION TO FISCAL:
REFUND WILL NOT BE ISSUED WITHOUT THE NAMES AND SIGNATURES OF AUTHORIZED STAFF
1st Reviewer Print:______________________________
Signature:______________________________
Date:
2nd Reviewer Print: _____________________________
Signature:______________________________
Date:
Refund Amount: $
Mandatory Comments:
7
Internal Use Only-Central Administration:
Control #:
Approve
Disapprove
1st Reviewer Print:______________________________
Signature:______________________________
Date:
2nd Reviewer Print: _____________________________
Signature:______________________________
Date:
Refund Amount: $
Mandatory Comments:
8
FMS Date:
FMS CRE #:
FMS Approver Print:
6/13
build safe │ live safe
ADVERTISEMENT
0 votes
Related Articles
Related forms
Request, Replace, Or Deactivate Nys Fuel Credit Card Request Form - New York Office Of General Services
Legal
Instructions For Form Ft-1006 - Application For Refund Of The New York State Diesel Motor Fuel Tax By An Omnibus Carrier
Business
Form Ft-1006 - Application For Refund Of The New York State Diesel Motor Fuel Tax By An Omnibus Carrier
Financial
Related Categories
Parent category: Legal