Application For Appeal Of The Disability Rent Increase Exemption Determination Form
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5DRIE
NYC DEPARTMENT OF FINANCE
LEGAL AFFAIRS DIVISION
APPLICATION FOR APPEAL OF THE
G
APPEAL
DISABILITY RENT INCREASE EXEMPTION DETERMINATION
TM
(By Tenant or Property Owner)
Finance
Mail to: NYC Department of Finance, Legal Affairs Division, DRIE Appeals Board,
345 Adams Street, 3rd Floor, Brooklyn, New York 11201
Instructions:
If you are an applicant with a disability, use this form to appeal
FOR OFFICE USE ONLY
Finance's denial of a Disability Rent Increase Exemption benefit. If you are a
property owner, use this form to appeal Financeʼs approval of a Disability Rent
Increase Exemption benefit for a tenant. Finance must receive your appeal ap-
plication within 60 days of the date on Finance's notification of DRIE approval or
denial to either the tenant or to the landlord. See Appeal Instructions for further
guidance and recommended forms of proof to support your claim on appeal.
Indicate DRIE
Application ID #:______________________
SECTION A - FILERʼS INFORMATION
1. Tenant/Property Owner
Name: a. ________________________________
b. ________________________________
FIRST NAME
LAST NAME
K
K
2. Check one: a.
I am the applicant with the disability.
b.
I am the property owner.
3. Indicate your Social Security Number
OR
Employee Identification Number
(
)
4. Daytime
5. Email
____
______________
Phone Number:
Address: ____________________________
6. Name of Preparer: _____________________________________________________________
FIRST NAME
LAST NAME
(If other than DRIE Applicant/Owner)
7. Relationship of Preparer to DRIE Applicant/Owner: ____________________________________
(
)
8. Daytime
9. Email
____
______________
Phone Number:
Address: ____________________________
SECTION B - PROPERTY INFORMATION
10. Building Address:____________ _____________________________________ ___________
. #
NUMBER
STREET NAME
APT
11. Borough: __________________________________________ 12. Zip Code: ______________
13. Filerʼs Mailing Address:_________
______________________________________ _______
. #
(If different from above)
NUMBER
STREET NAME
APT
14. City: ______________________________ 15. State_______ 16. Zip Code: ______________
Visit Finance at nyc.gov/finance
DRIE Appeal- 05/29/09
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