Form Ex-01 - Exemption Application For Owners - 2013-2014 Page 3
ADVERTISEMENT
1
2
3NEW YORK CITY DEPARTMENT OF FINANCE
PROGRAM OPERATIONS DIVISION
EXEMPTION APPLICATION FOR OWNERS 2013/2014
G
TM
Finance
ADDITIONAL OWNERS INFORMATION AND CERTIFICATION
INSTRUCTIONS: If the property is owned by more than two owners, please complete the additional ownerʼs
information below, sign and date and mail this sheet along with your completed application.
ADDITIONAL OWNER(S) INFORMATION
If there are more than 6 owners, please copy this sheet and complete as required.
Owner #3:
a._____________________________________
b. _______________________________________
FIRST NAME
LAST NAME
c. Date of Birth:
d. Social Security #:
e. Phone: ____________________
MM
DD
YYYY
f. Email: __________________________________________ g. Is this Owner #3ʼs Primary Residence?
YES
NO
I I
I I
h. Relationship to other owners: _______________________________________________________________________________
Owner #4:
a._____________________________________
b. _______________________________________
FIRST NAME
LAST NAME
c. Date of Birth:
d. Social Security #:
e. Phone: ____________________
MM
DD
YYYY
f. Email: __________________________________________ g. Is this Owner #4ʼs Primary Residence?
YES
NO
I I
I I
h. Relationship to other owners: _______________________________________________________________________________
Owner #5:
a._____________________________________
b. _______________________________________
FIRST NAME
LAST NAME
c. Date of Birth:
d. Social Security #:
e. Phone: ____________________
MM
DD
YYYY
f. Email: __________________________________________ g. Is this Owner #5ʼs Primary Residence?
YES
NO
I I
I I
h. Relationship to other owners: _______________________________________________________________________________
Owner #6:
a._____________________________________
b. _______________________________________
FIRST NAME
LAST NAME
c. Date of Birth:
d. Social Security #:
e. Phone: ____________________
MM
DD
YYYY
f. Email: __________________________________________ g. Is this Owner #6ʼs Primary Residence?
YES
NO
I I
I I
h. Relationship to other owners: _______________________________________________________________________________
ADDITIONAL OWNER(S) SIGNATURES - CERTIFICATION
ALL OWNERS MUST SIGN AND DATE THIS APPLICATION, WHETHER THEY RESIDE ON THE PROPERTY OR NOT
By signing below, I certify that all statements made on this application are true and correct to the best of my knowledge
and that I have made no willful false statements of material fact. I understand that this information is subjected to audit
and should Finance determine that I do not qualify for tax exemption, I will be disqualified from future exemptions and
will be responsible for all applicable taxes due, accrued interest, and the maximum penalty allowable by law.
___________________________________________________
_________________________
#3
OWNER
SIGNATURE
DATE
___________________________________________________
_________________________
#4
OWNER
SIGNATURE
DATE
___________________________________________________
_________________________
#5
OWNER
SIGNATURE
DATE
___________________________________________________
_________________________
#6
OWNER
SIGNATURE
DATE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial