NYS BOARD OF REAL PROPERTY SERVICES
RP-466-e [Lewis] (1/05)
APPLICATION FOR VOLUNTEER FIREFIGHTERS /
VOLUNTEER AMBULANCE WORKERS EXEMPTION
(For Use In Lewis County Only)
APPLICATION MUST BE FILED WITH YOUR ASSESSOR OR OTHER DESIGNATED
LOCAL OFFICIAL ON OR BEFORE TAXABLE STATUS DATE
Do not file application with State Board of Real Property Services
1. Name and telephone number of owner (s)
2. Mailing address of owner (s)
____________________________________________
_________________________________________
____________________________________________
_________________________________________
Day No. (___)________________________________
_________________________________________
Evening No. (___)____________________________
_________________________________________
3. Location of property
(Street address)
(Town)
(Village if any)
(School District)
Lewis County
Property identification (see tax bill or assessment roll)
Tax map number or section/block/lot: ____________________________________________________________
4. Name of incorporated volunteer fire company, fire department or incorporated volunteer ambulance service:
___________________________________________________________________________________________
5. Relationship to incorporated volunteer fire company, fire department or incorporated volunteer ambulance
service indicated in question 4:
? certified by company, department or service as enrolled member for at least five years; or
? certified by company, department or service as having accrued at least 20 years of active service
(see instructions)
6. Does the applicant reside in the city, town, or village served by the incorporated volunteer fire company, fire
department or incorporated volunteer ambulance service indicated in question 4?
? yes
? no
7. Is the property the primary residence of the applicant?
? yes
? no
8. Does the applicant or do the applicant and his/her spouse own the property?
? yes
? no (attach proof
of ownership.)
9. Is any portion of the property used for other than residential purposes (farming, commercial, vacant land,
professiona l office, etc.)? ? yes
? no
If yes, explain such use and describe the portion that is so used. __________________________________
_________________________________________________________________________________________
10. Did the applicant previously receive a village tax exemption for service as a volunteer firefighter pursuant to
section 466 of the Real Property Tax Law?
? yes
? no
If yes, indicate name of village and last year in which exemption was granted. ___________________