2017/18 Tax Benefits Application For Homeowners - New York City Department Of Finance Page 3
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5Homeowners Tax Benefits Application
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SECTION 8 - VETERAN HOMEOWNERS
Yes
no
Are any of the owners a veteran who served during a period of conflict?
n
n
List years of service. Ex.: 1965 - 1972________________________________________
Are any of the owners a spouse or a widow/er of a veteran who has not
Yes
no
remarried or a parent of a solder killed in action?
n
n
Yes
no
Did the veteran serve in a combat zone or theater?
n
n
If yes, where? (combat zone or theater)________________________________________
Was the veteran disabled in the line of duty?
Yes
no
n
n
If yes, submit a copy of a letter from the VA documenting the disability rating for each veteran.
Yes
no
I submitted a copy of the DD-214 or separation papers for each veteran.
n
n
SECTION 9 - CLERGY INFORMATION
Yes
no
Are you an active member of the clergy primarily responsible for ministerial work?
n
n
If no, were you unable to perform such work due to an illness or impairment?
Yes
no
n
n
Yes
no
Are you over age 70?
n
n
Yes
no
Are you an unmarried surviving spouse of the clergy member?
n
n
Yes
no
Do you have any secular employment which may make you ineligible for the exemption?
n
n
If Yes, please explain:__________________________________________________________________________________
Check the box(es) indicating the documentation you submitted to prove eligibility.
Yes
no
I submitted a verification letter from the church employer
n
n
Yes
no
I submitted a physicianʼs statement documenting the illness or impairment
n
n
Yes
no
I submitted a copy of a government-issued ID, birth certificate or baptismal certificate
n
n
Yes
no
I submitted a copy of my marriage certificate and a copy of my spouseʼs death certificate
n
n
SECTION 10 - CERTIFICATION AND CONTACT INFORMATION
By signing below, I certify that all statements made on this application are true and correct to the best of my knowl-
edge and that I have made no willful false statements of material fact. I understand that this information is subject to
audit and should the Department of Finance determine that I made false statements, I may lose my future exemptions
and be responsible for all applicable taxes due, accrued interest, and the maximum penalty allowable by law.
Important: By submitting this application, you acknowledge that you are required to notify DOF of any
changes that may affect your eligibility for benefits.
ALL owners Must siGn AnD DAte tHis APPLicAtion, wHetHer tHeY resiDe on tHe ProPertY or not.
If there are more than two owners, please complete the Additional Owners Information and Certification.
#1
OWNER
: ___________________________________________
: ____________________________
SIGNATURE
DATE
#2
OWNER
: ___________________________________________
: ____________________________
SIGNATURE
DATE
How can we
contact you? _____________________________________
__________________________________________
PHONE NUMBER
EMAIL
MAILING INFORMATION
Mail this completed application and ALL REQUIRED DOCUMENTATION to:
nYc Department of Finance, P.o. Box 311, Maplewood, nJ 07040-0311
PRIVACY ACT NOTIFICATION - Under the Federal Privacy Act of 1974, if we ask you to give us your social security number, we must tell you whether or not
you are obligated to provide us with the social security number, our legal right to ask you for the information, and how we plan to use it. You must list your taxpayer
identification number (SSN, ITIN or EIN) in order to apply for an exemption from real property taxes. We are asking this information to make sure that our records
are accurate, and that you have submitted accurate information. Our legal right to require this information is contained in Section 1-102.1 of the Administrative Code.
This authorizes the Department of Finance to require any person to provide a taxpayer identification number so that we may administer and collect taxes.
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