2015/16 Exemption Application For Homeowners - New York City Department Of Finance Page 3
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5Exemption Application for Homeowners
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SECTION 7 - DISABLED HOMEOWNERS
Do any of the owners or their spouses receive disability income, such as: Social Security Disability Insurance,
Yes
no
Supplemental Security Income, Railroad Retirement Disability Benefits or a Disability Pension?
n
n
If yes, submit a copy of one of the following required documents:
Social Security Administration award letter
l
Railroad Retirement Board or the U.S. Postal Service award letter
l
State Commission for the Blind and Visually Handicapped certificate
l
SECTION 8 - VETERAN HOMEOWNERS
if Yes, list years of service.
YES
NO
ex: 1965 - 1972
Are any of the owners a veteran who served during a period of conflict?
Are any of the owners a spouse or a widow/er of a veteran who has not
remarried or a parent of a solder killed in action?
combat Zone or theater
YES
NO
Did the veteran serve in a combat zone or theater? If yes, where?
Was the veteran disabled in the line of duty? If yes, submit a copy of a
letter from the VA documenting the disability rating for each veteran.
I submitted a copy of the DD-214 or separation papers for each veteran.
In the past 12 months, have you or the other property owners sold property in New York State
Yes
no
that received a Veteran Homeowner Exemption?
n
n
If YES, Date of sale:
Address: ________________________________________________
,
,
MM
DD
YYYY
NUMBER
STREET
CITY AND ZIP CODE
SECTION 9 - CERTIFICATION AND CONTACT INFORMATION
By signing below, I certify that all statements made on this application are true and correct to the best of my knowledge
and that I have made no willful false statements of material fact. I understand that this information is subjected to audit
and should Finance determine that I made false statements, I will be disqualified from future exemptions and will be re-
sponsible for all applicable taxes due, accrued interest, and the maximum penalty allowable by law.
ALL owners Must sign AnD DAte tHis APPLicAtion, wHetHer tHeY resiDe on tHe ProPertY or not.
If there are more than two owners, please complete the Additional Owners Information and Certification.
#1
OWNER
: ___________________________________________
: ____________________________
SIGNATURE
DATE
#2
OWNER
: ___________________________________________
: ____________________________
SIGNATURE
DATE
How can we contact you?
_____________________________________________________________________________________________
PHONE NUMBER
EMAIL
MAILING INFORMATION
Mail this completed application and ALL REQUIRED DOCUMENTATION to:
nYc Department of Finance, P.o. Box 311, Maplewood, nJ 07040-0311
PRIVACY ACT NOTIFICATION - Under the Federal Privacy Act of 1974, if we ask you to give us your social security number, we must
tell you whether or not you are obligated to provide us with the social security number, our legal right to ask you for the information, and
how we plan to use it. You must list your taxpayer identification number (SSN, ITIN or EIN) in order to apply for an exemption from real
property taxes. We are asking this information to make sure that our records are accurate, and that you have submitted accurate infor-
mation. Our legal right to require this information is contained in Section 1-102.1 of the Administrative Code. This authorizes the Depart-
ment of Finance to require any person to provide a taxpayer identification number so that we may administer and collect taxes.
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