Form Po-0519 - Sidewalk Repair Charge - Installment Agreement printable pdf download

NEW YORK CITY DEPARTMENT OF FINANCE

PAYMENT OPERATIONS DIVISION

APPLICATION FOR CONVERSION OF SIDEWALK REPAIR

Finance

CHARGE INTO FOUR ANNUAL INSTALLMENTS

Mail to: New York City Department of Finance, Payment Operations Division, 59 Maiden Lane, 19th Floor, New York, NY 10038, Attention: Ricardo Shoy

S S E E C C T T I I O O N N I I - - O O W W N N E E R R S S H H I I P P / / P P R R O O P P E E R R T T Y Y I I N N F F O O R R M M A A T T I I O O N N

Complete only Section I and mail to address above without any payment. See Instructions for further details.

Borough: ___________________________________

Block: _______________________ Lot: ________________________

Applicant/Owner: ___________________________________________________________________________________________

PRINT FIRST NAME

PRINT LAST NAME

Address: __________________________________________________________________________________________________

NUMBER AND STREET

Daytime

City: ________________________________ State: ________ Zip Code: _________ Telephone Number: __________________

Sidewalk Improvement Assessment Number: ______________________________________________________________________

Total

Entered on the records of the NYC Dept. of Finance on _________________ 20_____ Assessment Amount: $ ____________________

S S E E C C T T I I O O N N I I I I - - C C E E R R T T I I F F I I C C A A T T I I O O N N A A N N D D S S I I G G N N A A T T U U R R E E

Once approved, application will be returned with a calculation of your quarterly installment payments. Please sign and date

where indicated below. Mail application, including first installment payment to the address above.

The undersigned, owner of the property described above hereby requests that the said assessment be converted into (4) four

annual installments of $ ______________________ plus interest. The first installment of $ _______________________ is

due upon approval of this application. The subsequent installments will become liens annually on the next anniversary

date of the original charge. Interest is calculated on the installment amount at the rate of 8.5% per annum, or at the cost

of the City borrowing rate each year, whichever is lower.

In the event of a default in payment of any installment, this agreement may be cancelled and the full unpaid balance of

the charge shall become immediately due and payable. Interest will be calculated from the original date of entry of the

charge to the date of payment.

______________________________

_______________________________

________

_________

________

Print Applicant/Owner’s Name

Applicant/Owner’s Signature

Date

FOR OFFICE USE ONLY

Approved: ____________________________________________________

____________

Department of Finance

Date

PO-0519 Rev. 10.19.12

Form Po-0519 - Sidewalk Repair Charge - Installment Agreement

Related Articles

Related forms

Related Categories