Request For Waiver From Electronic Filing Of Real Property Income And Expense (Rpie) Form 2009 (Page 2 of 2) in pdf

2009 Request for Waiver of RPIE Electronic Filing

Page 2

PART II: BASIS FOR WAIVER REQUEST

The Department of Finance may, for good cause, waive the electronic filing requirement and accept an RPIE in paper format.

Please state the reason(s) for your request to waive the electronic filing requirement for RPIE. Finance will let you know if your

Request for Waiver has been granted.

______________________________________________________________________________________________________________________________________________________________________

PART III: CERTIFICATION

I hereby certify that I am the owner. I certify that all information contained in this Waiver Application is true

and correct to the best of my knowledge and belief. I understand that the willful making of any false state-

ment of material fact herein will subject me to the provisions of law relevant to the making and filing of false

instruments and will render this Waiver Application null and void.

____________________________________________

________________________________________

_______________________

Signature

Name (print)

Date

PRIVACY ACT NOTIFICATION

The Federal Privacy Act of 1974, as amended, requires agencies requesting Social Security Num-

bers to inform individuals from whom they seek this information as to whether compliance is voluntary

or mandatory, why the request is being made and how the information will be used. The disclosure of

Social Security Numbers by owners is mandated by Section 11-102.1 of the Administrative Code of

the City of New York. Disclosure by lessees is voluntary. Disclosure is requested to facilitate the pro-

cessing of real property income and expense data. Such data, including any Social Security Numbers

so disclosed, are used for tax administration purposes. The data, including any Social Security Num-

bers, may be further disclosed to other departments or agencies, or to persons employed by such de-

partments or agencies, only for such purposes, or as otherwise provided by law or judicial order.

Request For Waiver From Electronic Filing Of Real Property Income And Expense (Rpie) Form 2009 Page 2

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