Exemption Eligibility Checklist - 2012 (Page 2 of 2) in pdf

Exemption Eligibility Checklist - 2012 Page 2

Exemption Eligibility Checklist

Please fill out parts A and B below. If we think you may be eligible for a senior,

disabled homeowner, or veteran exemption or meet the "Circuit Breaker" credit

or active duty military requirements, we will send an application.

If we approve you for a senior, disabled homeowner or a combat- or disability-

level veteran exemption or verify you meet the "Circuit Breaker" credit or active

military duty requirements, we will remove your property from the lien sale.

A. Check ALL of the following statements that apply to you.

My property is a 1- to 3-family house or residential condominium.

I own the property listed below and use it as my primary residence.

G G

By December 31, 2012, my spouse or I will be at least 65 years old and

G G

the total combined income for all owners is less than $37,400.

G G

One of the owners receives disability benefits and the total combined in-

come for all owners is less than $37,400.

G G

My spouse or I are active duty military personnel.

I am a veteran or a Gold Star parent.

G G

I received the New York State Property Tax Credit (the "Circuit Breaker"

G G

credit) for Tax Year 2011.

G G

B. You MUST fill in the following information below:

If you do not fill in items 1 through 6, we will not be able to send you an ex-

emption application. Item 8 is optional. Please print all information.

OWNERʼS NAME:_____________________________________________________

PHONE NUMBER: ( _ _ _ ) _ _ _ - _ _ _ _

STREET ADDRESS: ___________________________________________________

CITY: _______________________________________________________________

STATE:_________________________ 6. ZIP CODE: _______________________

BOROUGH: _______________________ BLOCK:

________ LOT: __________

EMAIL ADDRESS:_____________________________________________________

Mail to:

NYC Department of Finance, Lien Sale Exemptions Unit,

59 Maiden Lane, 22nd Floor, New York, NY 10038.

Exemption Eligibility Checklist - 2012 Page 2