2015/16 Exemption Application For Homeowners - New York City Department Of Finance Page 2
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5Exemption Application for Homeowners
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SECTION 3 - ADDITIONAL PROPERTY INFORMATION
Yes
no
Do any owners own additional property?
n
n
If YES, how many additional properties do all of the owners own? ___________________
If YES, please give the owner name, the additional property's address and exemptions received:
_________________________________ _________________________________
________________________________
OWNER NAME
STREET ADDRESS
CITY AND ZIP CODE
Exemptions Received:
Basic STAR
Enhanced STAR
Senior
Disabled
Veteran
n
n
n
n
n
Other: list the benefit(s) received here: __________________________________________
n
If you need to list additional properties that are owned, please complete the Additional Property Information and Certification page
of this application.
SECTION 4 - INCOME INFORMATION
I attached copies of the 2013 federal tax return and schedules for all owners and spouses.
Yes
no
n
n
If NO, I certify that I am not required to file and I have attached proof of 2013 earnings
Yes
(State income tax return, Social Security, 1099 forms, W-2).
n
Name of owner(s) not required to file tax forms: _______________________________________________________
Senior Citizen and Disabled Homeowners: Please attach documentation for any unreimbursed medical or prescription
expenses for 2013. Do not submit copies of unpaid bills.
SECTION 5 - OCCUPANCY INFORMATION
Yes
no
Do all the owners of the property presently occupy the property as their primary residence?
n
n
If NO, please answer the questions below:
Yes
no
Is an owner receiving medical care as an in-patient at a residential health care facility?
n
n
If YES, please give owner’s name: ________________________________ Date admitted
MM
DD
YYYY
Yes
no
Is an owner absent from the residence due to divorce, legal separation or abandonment?
n
n
If YES, please give owner name absent from the residence: _________________________________________________
Does a child (or children), including those of tenants, live on the property and attend
Yes
no
a New York City public school, Grades Pre-K to 12?
n
n
Is the property within a housing development that is controlled by a Mitchell-Lama,
Limited-Profit Housing Company, Limited Dividend Housing Company, Redevelopment
Yes
no
Company, or Housing Development Fund Company?
n
n
Yes
no
Do any of the owners receive SCRIE and/or DRIE benefits for the property?
n
n
SECTION 6 - SENIOR CITIZEN HOMEOWNERS
Yes
I included a copy of a government-issued ID for all owners who will be 65 or older by December 31, 2015.
n
In the past 12 months, have you or the other property owners sold property in New York State that
Yes
no
received a Senior Citizen Homeowner Exemption?
n
n
If YES, Date of sale:
Address: ________________________________________________
,
,
MM
DD
YYYY
NUMBER
STREET
CITY AND ZIP CODE
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