Application For The City Of Pittsburgh Gentrification Exemption Program Form
ADVERTISEMENT
1APPLICATION FOR THE CITY OF PITTSBURGH GENTRIFICATION EXEMPTION PROGRAM
For Information, Please call (412) 255-2617
Complete and return this form to: Department of Finance, Real Estate Division
Assessed Valuation
Gentrification Program
Current Year:____________________
414 Grant Street
Assessed Valuation
Pittsburgh, PA 15219
Prior Year:______________________
Application is for the tax year of _______________
Date of Application________________
Name of property owner(s)_____________________________________ Social Security #_______________________________
__________________________________________________________ Social Security #_______________________________
Disclosure of your social security number(s) is authorized under the authority of the Federal Privacy Act of 1974 5 U.S.C. section 522a;
the Social Security Act, 42 U.S.C. section 405 [C](2)(I) and the City Code Chapter 102.04
Ward______ Block and Lot #________________ Property Address_________________________________________________
Owner’ s Address: _________________________________________City, State & Zip __________________________________
Work Phone (
) _________________________
Home Phone (
) _________________________
Is the property used as your principal residence? Yes _____
No _____
How may years have you:
Owned the property? _____________________ Occupied the Property? _________________
Date of purchase _________________________________
Purchase Price _____________________________________
Was the property purchased with the assistance of Federal, State or Local Government grants and/or reduced financing programs?
Yes _____ No _____ (Please provide documentation of type of assistance. FHA and VA financing are excluded.)
Does the property contain more than one living unit? Yes _____ No _____
If yes, state number of units ________________
Have you been the principal resident and owner/occupant of one of these units for at least 10 years?
Yes _____ No _____
Is any part of the property used for commercial purposes? Yes _____ No _____
If yes, explain the use of the property and
attach a copy of the floor plan.
List the addresses at which improvements have been made that have resulted in the assessment increase for your neighborhood:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge believe it is true, correct and complete.
SIGNATURE _____________________________________________________ DATE _________________________________
MAILING ADDRESS ___________________________________________________ ZIP CODE _________________________
IMPORTANT: PLEASE ATTACH A COPY OF YOUR COUNTY OF ALLEGHENY NOTICE OF ASSESSMENT CHANGE
E:\Forms\Finance\gent.doc
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial