Form Ex-01 - Exemption Application For Owners - 2011
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1
2NYC DEPARTMENT OF FINANCE
PROGRAM OPERATIONS DIVISION
G
E X E M P T I O N A P P L I C AT I O N
TM
F O R OW N E R S
Finance
Mail to: NYC Department of Finance, P.O. Box 3120, Church Street Station, New York, NY 10008-3120
FAXES WILL NOT BE ACCEPTED
Instructions: Owners may be eligible for several exemption programs that reduce property taxes. This application can be
used to apply for the following exemption programs: Basic and Enhanced STAR (School Tax Relief), the Senior Citizen,
Veteran, Disabled, and Clergy exemptions. Read the instructions for further information on how to complete this application.
SECTION I - OWNER INFORMATION
List the names of all owners of the property, as shown on the deed or proprietary lease, or, if applicable, the
owner(s) of a life estate in the property. Attach a separate sheet if the property has more than two owners.
1. Owner #1ʼs Name:
a. _________________________________ b. ____________________________________
FIRST NAME
LAST NAME
c. Is this Owner #1ʼs primary residence?
YES
NO
K
K
d. Social Security #:
e. Date of Birth:
MM
DD
YY
f.
K
Check here if the applicant is the owner of a life estate in the property.
2. Owner #2ʼs Name:
a. ________________________________
b. ____________________________________
FIRST NAME
LAST NAME
c. Is this Owner #2ʼs primary residence?
YES
NO
K
K
d. Social Security #:
e. Date of Birth:
MM
DD
YY
f.
K
Check here if the applicant is the owner of a life estate in the property.
3. Are owners #1 and #2 husband and wife, siblings
YES
NO
K
K
or registered domestic partners?
SECTION II - PROPERTY INFORMATION
1. Address: a. __________ b. _______________________________________ c._______________
. #
#
HOUSE
STREET NAME
APT
2. Borough: ______________ 3. Block #: _________ 4. Lot #:_________ 5. Zip Code: ___________
6. When did you purchase your property?
MM
DD
YY
SECTION III - INCOME INFORMATION
1. Enter the federal adjusted gross income, but subtract unreimbursed medical
expenses, of all owners of the property, their spouses or registered domestic
partners who are required to file a federal tax return (see instructions).
$_______________
2. If all the owners were not required to file a federal tax return,
Not Required
K
check this box
to File
3. Do any of the owners listed in Section I or their spouses receive Social Security
Disability Insurance, Supplemental Security Income, Railroad Retirement
YES
NO
Disability Benefits, or other disability income (including disability pension)?
K
K
Effective July 1, 2011, to be eligible for Basic STAR, the Annual Adjusted Gross Income must be
$500,000 or less.
Visit Finance at nyc.gov/finance
EX-01 04.19.11
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