2017/18 Tax Benefits Application For Homeowners - New York City Department Of Finance Page 4
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5Homeowners Tax Benefits Application
Page 4
ADDITIONAL OWNERS INFORMATION AND CERTIFICATION
instructions: Please add each additional owner below in response to questions in Section 2 of the application. This
page is part of your application, and may be duplicated and attached if additional pages are necessary. If there are more
than six (6) owners, please copy this sheet and complete as required.
owner #3:
______________________________________
_________________________________________
FIRST NAME
LAST NAME
Date of Birth:
Social Security #:
MM
DD
YYYY
Yes
no
Is Owner #3 a New York State Resident?
n
n
If No, please give Owner #3's
primary residence address: ______________________________________________________________________
STREET ADDRESS
CITY
STATE
zIP CODE
Relationship to other owners: ____________________________________________________________________________
owner #4:
______________________________________
_________________________________________
FIRST NAME
LAST NAME
Date of Birth:
Social Security #:
MM
DD
YYYY
Yes
no
Is Owner #4 a New York State Resident?
n
n
If No, please give Owner #4's
primary residence address: ______________________________________________________________________
STREET ADDRESS
CITY
STATE
zIP CODE
Relationship to other owners: ____________________________________________________________________________
owner #5:
______________________________________
_________________________________________
FIRST NAME
LAST NAME
Date of Birth:
Social Security #:
MM
DD
YYYY
Yes
no
Is Owner #5 a New York State Resident?
n
n
If No, please give Owner #5's
primary residence address: ______________________________________________________________________
STREET ADDRESS
CITY
STATE
zIP CODE
Relationship to other owners: ____________________________________________________________________________
owner #6:
______________________________________
_________________________________________
FIRST NAME
LAST NAME
Date of Birth:
Social Security #:
MM
DD
YYYY
Yes
no
Is Owner #6 a New York State Resident?
n
n
If No, please give Owner #6's
primary residence address: ______________________________________________________________________
STREET ADDRESS
CITY
STATE
zIP CODE
Relationship to other owners: ____________________________________________________________________________
I certify that all statements made on this application are true and correct to the best of my knowledge and that I have
made no willful false statements of material fact. I understand that this information is subject to audit and should the De-
partment 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.
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