Form Scrie/drie - Senior Citizen Or Disability Rent Increase Exemption Adjustment To Abatement

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SCRIE/
NYC DEPARTMENT OF FINANCE
PAYMENT OPERATIONS DIVISION
DRIE
G
SENIOR CITIZEN OR DISABILITY RENT INCREASE EXEMPTION
ADJUSTMENT TO ABATEMENT
TM
Finance
Mail to: NYC Department of Finance, Attn: SCRIE/DRIE, 59 Maiden Lane, 19th Floor, New York, NY 10038
Instructions: Use this form if you are presently receiving either a SCRIE or a DRIE benefit and wish to apply for an adjustment to
your current abatement due to a fuel cost adjustment, MCI increase or J-51 reduction. Please forward the completed, signed appli-
cation with a copy of the DHCR Order that you received from the landlord/managing agent.
SECTION I - APPLICANT INFORMATION
1. Name of
Applicant: a. _________________________________________ b. _________________________________________
FIRST NAME
LAST NAME
2. Address: ______________ 3. _______________________________________________ 4. Apt. #: ______________
NUMBER
STREET NAME
5. Borough: __________________________________________________
6. Zip Code: ___________________________
7. Daytime Phone Number: (____) ____________________ 8. Email Address: ___________________________________
9. SCRIE Docket / DRIE Case #: ________________________
SECTION II - EXEMPTIBLE INCREASE
Increases must be authorized by DHCR for building wide improvements. The exemption can only be granted if the increase
for the improvement is applied to all units in the building. (The following is a list of some increases that are not covered by
SCRIE or DRIE: doormen, maid service, air conditioning, painting, garages, parking, storage facility and security deposits).
Please check reason for the adjustment below. Please attach a copy of the Order Providing MCI Increase.
10. Reason for Adjustment (check one):
Fuel Cost Increase
Major Capital Improvement (MCI)
J-51 Reduction
K
K
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SECTION III - CERTIFICATION
I certify that all information contained in this application is true and correct to the best of my knowledge and belief. I understand
that willful making of any false statement of material fact herein will subject me to the provisions of law relevant to the making
and filing of false instruments and will render this application null and void.
____________________________________________________________ ______________________________________
Signature of Applicant
Date
____________________________________________________________ ______________________________________
Signature of Preparer (If other than applicant)
Date
Would you like a copy of the SCRIE / DRIE Abatement Adjustment determination sent to the preparer?
Yes
No
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K
(If “YES,” provide the preparerʼs name and mailing address, daytime phone, and/or fax number below.)
Name of Preparer: ________________________________________ ___________________________________________
FIRST NAME
LAST NAME
Preparerʼs Address: ______________ _________________________________________________
_________________
. #
NUMBER
STREET NAME
APT
________________________________
________________ (______) ________________ (______) _______________
BOROUGH
ZIP CODE
PHONE NUMBER
FAX NUMBER
SCRIE / DRIE Adjust to Abate. 09/29/09

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