Senior Citizen Property Tax Exemption Application Form

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Senior Citizen Property Tax Exemption Application
Page 4
O F F I C E
U S E
O N L Y
Approved...............
Denied.............
Reason:
Reviewer: ______________
Date :___________
_______________________
SECTION 1 - OWNERSHIP / PERSONAL INFORMATION
1. Borough: _____________________________ Block: ______________________ Lot:________________
Address of Property:
____________________________________________________________ Zip Code: __________________
2. Type of residence (check one):
1-, 2-, 3-FAMILY HOME
CONDOMINIUM UNIT
COOPERATIVE APARTMENT - unit number: ___________
3.
Applicant/Owner
Social Security
Date of
Daytime Phone
Name and Daytime Phone
Name
Number
Birth
Number
Number of Relative or Friend
a. ____________________
_________________
_______
_____________
_________________
b. ____________________
_________________
_______
_____________
_________________
c. ____________________
_________________
_______
_____________
_________________
4. Personal status (check one) (Attach proof of status) (see instructions) :
SINGLE (includes divorced, unremarried widow or widower)
LEGALLY SEPARATED
MARRIED
5. Deed/proprietary lease status (check one) (see instructions for definitions) :
INDIVIDUAL
HUSBAND/WIFE
JOINT TENANTS
TRUST (Must submit copy of Trust Agreement)
TENANTS IN COMMON
LIFE ESTATE
SIBLINGS
6. Is the address the legal and primary residence of all of the owners?...................................
YES
NO
7. Is any owner now in a nursing home or institution?..........................................................
YES
NO
If "YES", state owner's name: _____________________________________ Date entered: _______________
8.
Is any person whose name appears on the deed/proprietary lease deceased? ...........................
YES
NO
If "YES", list name of deceased and attach a photocopy of the death certificate or other proof of death.
________________________________________________________________________________________
9a. Does the present deed/proprietary lease to the property indicate ownership of less than
12 months? .................................................................................................................
YES
NO
9b. If "YES", indicate address of previous property: __________________________________________________
_________________________________ Date of purchase: ______________
Date of sale: _____________
10a.Is any other property owned by the applicants? (If "YES", you must complete Section 3.).....
YES
NO
10b.Is your residence partially rented? (If "YES", you must complete Section 3.) ......................
YES
NO
11. Is the entire property, listed in item 1 above, used exclusively for residential purposes? .........
YES
NO
If "NO", explain use - Indicate percentage nonresidential: ___________________________________________
_______________________________________________________________________________________

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