Senior Citizen Rent Increase Exemption (Scrie) Application For Benefit Takeover

Senior Citizen Rent Increase Exemption (Scrie) Application For Benefit Takeover - 2011

NYC DEPARTMENT OF FINANCE

PROGRAM OPERATIONS DIVISION

SENIOR CITIZEN RENT INCREASE EXEMPTION (SCRIE)

APPLICATION FOR BENEFIT TAKEOVER

Finance

Mail to: NYC Department of Finance, SCRIE Program, 59 Maiden Lane, 22nd Floor, New York, NY 10038

If you need assistance in completing this application, please call 311.

GENERAL INSTRUCTIONS

Use this application only if you are a surviving family member or domestic partner of

the recently deceased SCRIE beneficiary, have been granted succession rights and

meet SCRIE eligibility criteria, which means:

You must be 62 years of age or older

Your annual household income is $29,000 or less

This application must be filed within 30 days of the date of death of the beneficiary.

Please answer all questions, sign and return to the address listed below. Remember

to enter the docket number of the current SCRIE account. For further information or

instructions, please dial 311 or write to:

NYC Department of Finance

SCRIE Program

59 Maiden Lane, 22nd Floor

New York, NY 10038

APPLICATION CHECKLIST

Be sure that you have:

Attached copy of death certificate

Attached copy of your new lease or other proof that succession

rights were granted by the landlord

Included income for all household members

Proof of last income reported for deceased

Signed and dated the application

Senior Citizen Rent Increase Exemption (Scrie) Application For Benefit Takeover - 2011