Nassau County Property Tax Exemption Application
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42015-2016 Persons with Disabilities and Limited Incomes
Property Tax Exemption Application
(Nassau County does not charge a fee to file this application.)
Any alteration of this application may result in a denial.
Property Address
House Number & Street: ________________________________________________________________ Apt. Number: ______________
City: _____________________________________________ State: ____________________________ Zip Code: _________________
Property Identification
TOWN ______ S.D. ______ SECTION ______ BLOCK _______ LOT ________ CA/BLDG. # _________TAX UNIT # _________
For Condos & Co-ops only
Ownership
Marital Status
Names of ALL Owners
Date of Birth
(Married, Divorced,
Social Security Number
(as recorded on latest Deed)
Widowed, Single)
a)
b)
Telephone Number:
Day (
) ___________________ Evening (
) ___________________ Fax (
) ___________________
Proof of Ownership (Indicate ALL documents that apply and submit them with this application. Co-op owners must attach a
copy of the CERTIFICATE OF SHARES.)
Latest recorded Deed – Liber/Deed # _______________ Page # ________________
Other: ____________________________
Probated Will(s) of deceased owner(s)
Entire Trust (If property is in a Trust)
If any owner appearing on any proof of ownership or the spouse of any owner is deceased, a Death Certificate must be included with this application.
Proof of Age (Indicate documents submitted for ALL owners)
Birth Certificate
Driver’s License
Passport
Naturalization Papers
Other: ____________________________
Proof of Residency (Indicate documents submitted for ALL owners)
2013 Social Security 1099
Current NYS car registration
2013 NYS Resident Income Tax Return
a. Do all owners presently reside on the property to be exempted?
Yes
No
b. Is the non-resident owner absent from the residence due to divorce, legal separation or abandonment?
Please Explain: ____________________________________________________________________
Yes
No
c. Is an owner receiving medical care as an inpatient in a health care facility?
Yes
Date admitted ________________
No
Does a child (or children), including those of tenants, reside on the property and attend a public school, Grades Pre-K
to 12?
Yes
No
Name & Location of school(s): ______________________________________________________________________________________
NOTE: If children attend school, a letter from the school is required verifying student’s enrollment.
NAME(S) of ALL adults and children
AGE of Others Living in the Household
Rent/Contribution to Household Per Month
Living in the Household
Proof of Disability (Notice of Award letter must be included with this application)
Social Security Administration for entitlement to Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)
Railroad Retirement Board for entitlement to Railroad Retirement Disability benefits
Certificate from NYS Commission for the Blind and Visually Handicapped stating that applicant is legally blind
United States Postal Service verifying entitlement to a disability pension, and/or
VA Disability Pension
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