Form Ref-01 - Property Refund Request - 2015 Page 2
ADVERTISEMENT
1
2
3Property Refund Request Form
Page 2
SECTION III - ACCOUNT CREDIT INFORMATION
Please check one of the following to indicate the reason there is a credit on this account:
Overpayment. Indicate the amount: $ _________________________
Date of payment:________/________/________
q
MONTH
DAY
YEAR
Reduction in assessed property value
q
The reduction is due to a court order.
(Please provide a copy of the court order if interest must be paid on the refund.)
q
Abatements or Exemptions
q
Senior Citizen Rent Increase Exemption (SCRIE)
q
Disability Rent Increase Exemption (DRIE)
q
Other (Please explain):_________________________________________________________________________
q
Cancellation of a charge already paid
q
Payment made erroneously
q
Other (Please explain): ___________________________________________________________________________
q
SECTION IV - PAYMENT INFORMATION
Please note that attorneys filing based on reductions in assessed value do not need to complete this section.
Check one of the choices below to indicate how payment of the charges was made that resulted in the credits. If you are fil-
ing this request based on a missing or misapplied payment, you must attach proof of payment. You must also provide
proof if payment was made by a mortgage company for multiple parcels. Acceptable proof of payment is listed after each choice.
Cash or check paid at a Finance Business Center. Please provide receipt number _________________________ or
q
attach a copy of receipt.
Check mailed. Please attach a copy of the front and back of the cancelled check.
q
Credit/Debit Card. Indicate Transaction Confirmation Number or Receipt Number: ___________________________
q
Payment made by mortgage company or bank. Please attach a copy of the front and back of the cancelled check or proof
q
of Fedwire payments. For payments made for multiple properties, you must also provide a disbursement sheet showing
how payment was to be allocated.
Other: __________________________________________________________________________________________
q
SECTION V - CREDIT OPTION INFORMATION
Please select one of the following choices in A. ENTIRE REFUND or B. PARTIAL REFUND to indicate how you want your
credit distributed:
A.
ENTIRE REFUND
q
I want the entire credit to be refunded to me in the form of a refund check.
q
I want the entire credit to be transferred to the below property, which I also own. (Please note that credits that result-
q
ed from an attorney action generally may not be transferred and must be refunded.) Please indicate the amount to
be transferred, the account type to where the money should be transferred (see #3 in the instructions for more infor-
mation), and the period to which the money should be applied below.
Borough _______________________ Block __________________________ Lot __________________________
AMOUNT
ACCOUNT TYPE
PERIOD
/
/
$ ___________________________________ _______________________________ _______
_______
_______
/
/
$ ___________________________________ _______________________________ _______
_______
_______
/
/
$ ___________________________________ _______________________________ _______
_______
_______
/
/
$ ___________________________________ _______________________________ _______
_______
_______
Section V continues on Page 3.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal