Partial Property Tax Exemption Application For Clergy Form - Nyc

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NYC DEPAR TMENT OF FINANCE
PAYMENT OPERATIONS
PAR TIAL PROPER TY TAX EXEMPTION APPLICATION FOR CLERGY
FINANCE
Mail to:
NEW YORK
THE CITY OF NEW YORK
NYC Department of Finance, Clergy Exemption, P.O. Box 3120 Church Street Station, New York, NY 10008-3120
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
Please complete and return this application with the required supporting documentation to the Finance Business Center in your borough. See instructions for further information.
S E C T I O N
I - A P P L I C A N T I N F O R M A T I O N
Proof of ownership, such as a copy of a deed, must be attached with this completed form.
1. Property Owner’s Name:
Borough:
Block:
Lot:
2. Property Address:
City:
State:
Zip Code:
County:
3. Mailing Address:
City:
State:
Zip Code:
County:
(If different from property address)
4. Telephone Number:
5. E-mail Address:
6. Is the applicant a resident of the State of New York?.......................................................................................................
YES
NO
S E C T I O N
I I - E X E M P T I O N I N F O R M A T I O N
7. Is the applicant engaged in ministerial work assigned by his/her church or denomination? ............................................
YES
NO
8. Is this work the applicant’s principal occupation? ............................................................................................................
YES
NO
If YES, indicate: Name and address of church or denomination: ___________________________________________________________
_______________________________________________________________________________________________________________
If YES, attach a letter of reference from the church employer.
If NO, indicate alternative basis for exemption below:
Applicant is unable to perform his/her religious duties due to impaired health. (Documentation, such as physician’s statement, must be attached.)
Applicant is over seventy years of age. (Documentation, such as birth certificate or baptismal certificate must be attached.)
Applicant is the unmarried surviving spouse of a clergyperson who met the requirements of this statute at the time of his/her death.
Name of deceased spouse: ____________________________________________________________________________________
Name and address of deceased
spouse’s church or denomination: Name: _________________________________________________________________________
Address: _______________________________________________________________________
S E C T I O N
I I I - E M P L O Y M E N T I N F O R M A T I O N
9. Is the applicant engaged in secular employment? ..........................................................................................................
YES
NO
If YES, complete a) and b) below:
a) Amount of time devoted to:
Secular employment per year ____________________________
}
Indicate what percentage of
= 100%
work is secular and what
Religious duties per year ________________________________
percentage is religious.
b) Description of secular duties: ____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
S E C T I O N
I V - O T H E R E X E M P T I O N P R O P E R T Y I N F O R M A T I O N
10. Does the applicant own another property in the State of New York which is exempt from taxation
pursuant to this statute? .................................................................................................................................................
YES
NO
If YES, complete a) and b) below:
a) Location of the property: Address: ________________________________________________________________________________
City: _____________________________ State:________
Zip Code: _________ County: ____________
b) Amount of Exemption:
$
____________________________________________________________________________________
S E C T I O N
V - C E R T I F I C A T I O N
I, __________________________________________________________________, hereby certify that the information on this application and any
Print Name of Owner/Applicant
accompanying material constitute a true statement of fact.
___________________________________________________________________
_____________________________________________
Signature of Owner/Applicant or Authorized Representative
Date
YOU MUST RETAIN A COPY OF YOUR COMPLETED APPLICATION AND APPLICABLE DOCUMENTATION FOR YOUR RECORDS.

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