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NEW YORK CITY DEPARTMENT OF FINANCE

FORM

COOPERATIVE TRANSFER SUMMARY RETURN

AND COOPERATIVE ABATEMENT APPLICATION

RPT-CC/CA

FINANCE

TO BE COMPLETED BY AN OFFICER OR REPRESENTATIVE

NEW YORK

THE CITY OF NEW YORK

OF COOPERATIVE HOUSING CORPORATIONS

DEPARTMENT OF FINANCE

n y c . g o v / f i n a n c e

FOR THE PERIOD: JANUARY 6, 2004 - JANUARY 5, 2005

DUE DATE:

FEBRUARY 15, 2005

Cooperative Name:

DEVELOPMENT NAME: ___________________________

PROPERTY LOCATION: ___________________________

________________________________________________

Cooperative Address

(number and street)

BOROUGH: _____________________________________

BLOCK: ________________________________________

LOT: ___________________________________________

City

State

Zip Code

CO-OP #:________________________________________

EIN: ___________________________________________

Contact Telephone Number: _________________________________________

Extension: ___________________________________

Mailing address (If different from above): ____________________________________________________________________________

City: _______________________________________________ State: ___________________________ Zip: _____________________

SECTION A - See Instructions

MAIL THE COMPLETED FORM TO:

CHECK IF

No transfers occurred during the period covered by this form.

New York City Department of Finance

CHECK ONE OF THE FOLLOWING

66 John Street, 12th Floor

Cooperative Abatement Application (new)

New York, NY 10038

Cooperative Abatement Renewal (continuing)

Cooperative not eligible or otherwise not participating in

abatement program

- STOP HERE -

If Schedule CA is attached, you may be able to omit Section B

and instead update Schedule CA.

- SEE INSTRUCTIONS BEFORE CONTINUING -

SECTION B

Apartment address, if different from property location above:

Address: ___________________________________________ City: _______________________ State: _____________ Zip:_________

Apartment No.:

Check one

INITIAL SALE

RESALE

OTHER

_________________________________________

Was apartment used for business?

YES

GRANTOR

Name:

___________________________________________________________________________________________________________________________________________________________

Address after closing date: ___________________________ City: _______________________ State: _____________ Zip:_________

Employer identification number or social security number:

_______________________________________________________________________________________________

Date of transfer: _____/ ______/

Consideration: $ _________________

Number of Shares:

____________

___________________________

GRANTEE

Name:

___________________________________________________________________________________________________________________________________________________________

Address after closing date: ___________________________ City: _______________________ State: _____________ Zip:_________

Employer identification number or social security number:

_______________________________________________________________________________________________

SECTION C -

CERTIFICATION OF AN ELECTED OFFICER OF THE CORPORATION

I hereby certify that this form, including any accompanying rider, is to the best of my knowledge and belief, true, correct and complete.

______________________________________________

____

_______________________________________

__________________________

SIGNATURE OF OFFICER

TITLE