Form Ref-01 - Property Refund Request - 2015

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PROPERTY REFUND REQUEST
NEW YORK CITY DEPARTMENT OF FINANCE
PROGRAM OPERATIONS DIVISION
REFUNDS UNIT
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TM
Finance
Mail to: NYC Department of Finance, Refunds Unit, 59 Maiden Lane, 20th Fl., New York, NY 10038
INSTRUCTIONS: Please read the instructions for further details before completing this form. Please print all
information and initial any changes that you make on this application.
SECTION I - GENERAL INFORMATION - All information must be provided.
1. Property Address: ____________________________________________________________________________________
Zip
NUMBER AND STREET
2. City: _____________________ State:_____ Code: ________ 3. Borough:_________ Block: ________ Lot(s): __________
4.
I made a payment on an incorrect property. If you checked this box, complete the following:
q
Incorrect Property: Borough: _________________ Block:_______________________ Lot:_______________________
q
q
q
5. Type of Request
Refund
Apply Credit to Another Property
Missing/Misapplied Payment
(Check the applicable choice(s)):
q
Direct Deposit
q
Paper Check
6. If you checked Refund in # 5, how would you like to receive it?
(Check only one box):
7. If you checked Direct Deposit in #6, complete 7a, b and c.
a. ABA or Routing Number:
b: Bank Account Number:
c: Account Type:
Checking
Savings
q
q
8. If you checked Paper Check in #6, complete 8a, b and c.
a. Make Refund Check Payable to: ___________________________________________________________________
(
)
PRINT NAME
OR FIRM IF APPLICABLE
b. Mail the Refund Check to this address: ______________________________________________________________
/
NUMBER AND STREET
APT
FLOOR
c. City: _________________________________________ State:_________________ Zip Code: _________________
SECTION II - FILER INFORMATION
1. Filer’s Name: _________________________________________________________________________________________
PRINT FIRST NAME
PRINT LAST NAME
2. Firm Name (if applicable): ____________________________________________________________________________
Email
3. Telephone Number: (____) _________________ Extension: _________ Address: _______________________________
4. Please indicate your relationship to the property:
Current Owner
q
/
/
Please indicate the date you took ownership of the property: _______
_______
_______
q
Prior Owner
/
/
Please indicate the date when you sold the property: _______
_______
_______
q
Officer of the cooperative management board
Representative of the mortgage company or bank that pays the property taxes
q
Escrow Account/
Customer Name: ___________________________________________ Loan Number: ________________________
PRINT FIRST NAME
PRINT LAST NAME
q
Title Company
Name of Title Company: ______________________________________ Title Number: ________________________
Member of the condominium management board
q
q
Attorney/legal representative that brought an assessment reduction resulting in credit
/
/
Attorney Name: ___________________________ Attorney Group #: ______ Tax Periods: ____
_____ to ____
_____
q
Not the attorney/legal representative that brought the action that resulted in the credit, but I have a letter of authorization from
that attorney/legal representative authorizing me to request this refund. (Attach a copy of the letter.)
Other. Please explain the nature of your relation to the property owner (e.g., family member, managing agent, executor
q
of estate or trustee, etc.): __________________________________________________________________________
Visit Finance at nyc.gov/finance
REF-01 - Rev. 02.10.2015

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