Form Drie - Disability Rent Increase Exemption Adjustment To Abatement printable pdf download

DRIE

NYC DEPARTMENT OF FINANCE

PAYMENT OPERATIONS DIVISION

DISABILITY RENT INCREASE EXEMPTION

ADJUSTMENT TO ABATEMENT

Mail to: NYC Department of Finance, Attn: DRIE, 59 Maiden Lane, 19th Floor, New York, NY 10038

Instructions: Use this form if you are presently receiving a DRIE benefit and wish to apply for an adjustment to your current abate-

ment due to a fuel cost adjustment, MCI increase or J-51 reduction. Please forward the completed, signed application with a copy

of the notice of adjustment that you received from the landlord/managing agent.

SECTION I - APPLICANT INFORMATION

1. Name of Applicant

with a Disability: 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. DRIE Application #: ________________________________

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

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

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 with a Disability

Date

____________________________________________________________ ______________________________________

Signature of Preparer (If other than applicant)

Date

Would you like a copy of the DRIE Abatement Adjustment determination sent to the preparer?

Yes

(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

DRIE Adjust to Abate. 12/24/08

Form Drie - Disability Rent Increase Exemption Adjustment To Abatement

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