Application Form For Enhanced Star (School Tax Relief) Property Tax Reduction For Senior Citizens, 65 Years Of Age Or Older - State Of New York Page 2
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1
2NYC DEPARTMENT OF FINANCE
PAYMENT OPERATIONS DIVISION
E N H A N C E D S TA R
F I N A N C E
NEW YORK
I N C O M E S TAT E M E N T
THE CITY OF NEW YORK
DEPARTMENT OF FINANCE
Only applicants for ENHANCED STAR who did not file federal or New York State tax returns for 2004
or 2003 should complete this form. See Enhanced STAR Income Statement Instructions for further
details on completing this form.
SECTION I - OWNER AND PROPERTY INFORMATION
A. OWNER’S NAME
Indicate names of all owners who do not have a federal or New York State tax return to submit as proof of income:
__________________________________________________________________________________
____________________________________________________________________________
Print Owner’s Name
Print Owner’s Name
__________________________________________________________________________________
____________________________________________________________________________
Print Owner’s Name
Print Owner’s Name
B. PROPERTY
___________________________________________________________________________________________________________________________________
Street Address
Apt. # (Required, if applicable)
ADDRESS
___________________________________________________________________________________________________________________________________
City/Town
State
Zip Code
SECTION II - INCOME INFORMATION
A. INCOME FOR TAX YEAR 2004
$
1. Total wages, salaries, tips, bonuses. (Attach a W-2 and/or 1099) ....................... 1. ________________________
2. Taxable interest income and dividends ................................................................ 2. ________________________
3. Unemployment compensation .............................................................................. 3. ________________________
4. Total Pensions and annuities. (Do not include IRA distributions.
Attach Form 1099 for items 4 and 5) ................................................................... 4. ________________________
5. Social Security benefits ....................................................................................... 5. ________________________
6. Other income (list type(s) of other income on line below).................................... 6. ________________________
__________________________________________________________________________________________
7. Add lines 1 through 6 .......................................................................................... 7. ________________________
8. Adjustments to income (list type(s) of adjustments on line below) ...................... 8. ________________________
__________________________________________________________________________________________
$
9. Subtract line 8 from line 7. This is your adjusted gross income .................... 9. ________________________
SECTION III - CERTIFICATION
I/We certify that all of the above information is correct and that I/we are not required to file a New York State or federal
income tax return. All owners whose incomes are included in these calculations must sign below.
____________________________________________________ _______________________
____________________________________________________ _______________________
Signature
Date
Signature
Date
____________________________________________________ _______________________
____________________________________________________ _______________________
Signature
Date
Signature
Date
____________________________________________________ _______________________
____________________________________________________ _______________________
Signature
Date
Signature
Date
STAR/EnhIncStat- Rev 06/20/05
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