Nassau County Property Tax Exemption Application (Page 3 of 4) in pdf

CERTIFICATION

(All Owners Must Sign)

I (We) certify that all of the above information made on this application is true and correct and that the property listed above is my (our)

legal primary residence. I (We) understand it is my (our) obligation to provide any documentation of eligibility that is requested and to

notify the assessor if I (we) relocate to another primary residence. I (We) understand that any willfully false statements of fact will be

grounds for disqualification from further exemption for a period of five years and a fine as set forth in New York State Real Property Tax

Law #459-c.

___________________________________

_______________

______________________________________ _______________

Signature

Date

Signature

Date

(If signed by an Attorney-in-fact, a PHOTOCOPY of the Power of Attorney must be included with this application.)

Section 459-c of the Real Property Tax Law gives local governments and public school districts the option of granting a reduction in the

amount of property taxes paid by qualifying persons with disabilities. To qualify, persons with disabilities generally must have certain

documented evidence of their disability and meet certain income limitations and other requirements.

APPLICATION INSTRUCTIONS

1. Fill out the application completely.

2. The name on the Deed or Shares must correspond with the name on the application. For exceptions to this requirement, see the

checklist below.

3. Attach proof of age, proof of primary residency, entire 2013 Federal and NYS Income Tax Returns, proof of any claimed un-

reimbursed medical expenses, a tax bill (if available) and any additional information required by this application and in the checklist

below.

4. Submit this signed, completed, original application with PHOTOCOPIES of the required documentation to the Senior Division at

the Department of Assessment on or before the taxable status date of January 2, 2015.

Please use the following list as a guide to assist you in providing the required documents.

CERTIFICATE OF SHARES OR PROPRIETARY LEASE (If you live in a Cooperative apartment)

LATEST DEED RECORDED WITH NASSAU COUNTY

PROOF OF AGE (Birth Certificate; Baptismal Certificate; Driver’s License; Naturalization Papers; Military ID or Passport)

PROOF OF PRIMARY RESIDENCE (SSA-1099, Car Registration or 2013 NYS Income Tax Return) All proof of residence

documentation must show the current address.

A COPY OF YOUR 2013 FEDERAL AND STATE INCOME TAX RETURN(S) (Required for all owners and their spouses) If

you are married and filed separately, include both tax returns. If you were not required to file an income tax return, you must attach proof

of all taxable and non-taxable income (i.e. 1099 Statements of Interest; Dividends; Pension; W-2; etc.) The Federal and NYS Income

Tax Return must have the applicant(s) name, address and SSN (s) on it. An IRS printout of all income statements may be required.

A COPY OF THE BUSINESS TAX RETURN (If you have an S-Corp, Partnership, Trust or Estate Income Tax Return)

PENSION/ VA DISABILITY AWARD LETTER (If you are receiving monies from your deceased spouse’s pension)

SOCIAL SECURITY AWARD LETTER (If you are receiving Social Security from a spouse deceased in 2013)

PRINTOUTS FROM A DOCTOR/DENTIST/PHARMACY FOR UN-REIMBURSED EXPENSES (Cancelled checks will not be

accepted as proof of un-reimbursed expenses)

A COPY OF THE ENTIRE TRUST (If your property is in a Trust, you must be the sole beneficiary during your lifetime)

A LETTER FROM THE SCHOOL (If any school age children, Grades K-12, reside at the property)

A COPY OF THE DEATH CERTIFICATE (If one of the owners on the Deed or their spouse is deceased)

A COPY OF DIVORCE OR LEGAL SEPARATION PAPERS (If the applicant is divorced or legally separated)

A RECORDED AFFIDAVIT CONFIRMING ABANDONMENT (If applicant claims abandonment, a notarized affidavit must be

submitted stating date of abandonment and intent to return)

A COPY OF THE PROBATED WILL (If the sole owner on the Deed is deceased)

LETTER FROM THE RESIDENTIAL HEALTH FACILITY (If the owner resides in a residential health care facility, the letter

must include the date of admission and date of expected discharge – if applicable)

Nassau County Property Tax Exemption Application Page 3

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