Form Tc159 - Affidavit In Support Of Application - 2011

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TAX COMMISSION OF THE CITY OF NEW YORK
TC159
1 Centre Street, Room 936, New York, NY 10007
2011
AFFIDAVIT IN SUPPORT OF APPLICATION
USE THIS FORM TO SUBMIT FACTUAL STATEMENTS OR DOCUMENTS. SUBMIT ONE ORIGINAL
WITH ANY ATTACHMENTS. READ THE INSTRUCTIONS ON THE REVERSE SIDE.
PROPERTY AND HEARING INFORMATION – Do not leave any item blank.
BOROUGH (Bronx, Brooklyn, Manhattan, Queens or Staten Island)
BLOCK
LOT
CONDO NUMBER
ASSESSMENT YEAR
2011/12
REPRESENTATIVE
TC GROUP NUMBER
HEARING DATE
CALENDAR PAGE
HEARING OFFICER
OTHER LOTS COVERED BY THIS SUBMISSION, IF ANY
STATEMENT OF AFFIANT – Include the purpose of this submission.
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
ATTACHMENTS – List all schedules and documents attached.
Attachment
Number of pages
__________________________________________________________________________________________________________
_________________________
__________________________________________________________________________________________________________
_________________________
__________________________________________________________________________________________________________
_________________________
__________________________________________________________________________________________________________
_________________________
Total pages attached
_________________________
The affiant states that the attachments are true copies, and that in the case of a lease, contract or other transaction that they
accurately describe the transaction and that the transaction is between unrelated persons dealing at arms-length except as otherwise
specified here:
__________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
OATH
The oath must be signed by an individual having personal knowledge of the facts. The submission of materially false or misleading
information is a crime.
Print name of person signing and relation to applicant:
_______________________________________________________________________
Specify source of personal knowledge:
_____________________________________________________________________________________
I, the person whose signature appears below, swear or affirm under penalty of perjury that the statements contained in this
affidavit, including attachments, are true to my personal knowledge, are free from misleading omissions, and may be relied
upon by the Tax Commission in making its determination. I understand that such statements are subject to verification.
Signature of affiant:
____________________Date:________________________
Sworn to before me:
County
State
Date
______________________________
_______________
_______/_______/_______
NOTARY STAMP
Signature of person administering oath:
___________________________________________

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