Application For Reimbursement Or Transfer Of Excess Senior Citizen Rent Increase Exemption (Scrie) Tax Abatement Credits - 2004 Page 3
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6Excess SCRIE Refund Application
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The option of cash reimbursement of excess SCRIE credit (instead of using such credit as an offset against future real estate taxes) IS NOT
AVAILABLE where the owner or in the case of corporate owners, any corporate officer, director or any person holding an interest in more
than 10% of the issued and outstanding stock of such corporation is in arrears in the payment of real estate taxes on any property in the City
of New York. In addition, if title is held by a nominee, the owner will be considered to be in arrears when the person for whose benefit such
title is held is in arrears in the payment of real estate taxes on any New York City property.
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All individuals and entities applying for cash reimbursement of Excess SCRIE credit (including but not limited to corporations, partnerships
and trusts) are required to provide the following information by completing the chart below. In addition, where the owner is a corporation,
specify each officer, director and any person holding over 10% stock interest in the corporation and provide the appropriate information in the
chart below. Also, where title to the property is held by a nominee, specify each beneficiary and complete the chart.
A
B
C
NAME
LIST BOROUGH, BLOCK & LOT
AMOUNT OF
LIST RELATIONSHIP
OF OTHER PROPERTY OWNED
REAL ESTATE
TO OWNER
IN NEW YORK CITY
TAX ARREARS
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P L E A S E
U S E
A
S E P A R A T E
S H E E T
F O R
A D D I T I O N A L
E N T R I E S
I hereby affirm that I am the current owner of the property and that all of the statements and information contained herein
are true and correct to the best of my knowledge. I further affirm that I have not previously applied for the excess SCRIE
sought herein, nor have I or, to the best of my knowledge, any prior owner claimed tax abatement for any period for which
excess SCRIE is sought in this application. I also acknowledge that the information herein is subject to audit and poten-
tial recoupment.
_____________________________________________________________
_______________________________________
(
)
NAME OF APPLICANT
TITLE
IF CORPORATE OFFICER
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______________________________________
(_______) _________________
_________/_________/_________
SIGNATURE OF APPLICANT
PHONE NUMBER
DATE
S
______
__________________, _____.
WORN TO AND SUBSCRIBED TO BEFORE ME ON THIS
DAY OF
'
NOTARY
S
STAMP
______________________________________
OR SEAL
SIGNATURE OF NOTARY
FILE THIS EXCESS SCRIE REFUND FORM WITH:
N O T E S
This form should be completed by the
NYC DEPARTMENT OF FINANCE
current owner.
Any other entity
EXCESS SCRIE UNIT
wishing to obtain the refund must
66 JOHN STREET, 1ST FLOOR
obtain the written consent of the
NEW YORK, NY 10038
current owner.
EXCESS SCRIE REFUND (05/04)
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