Form Nyc Ref-583 - Claim For Refund Or Transfer Of Credit For Overpayment Of Real Estate Taxes Or Improvement Assessments Page 2

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Form NYC-REF-583

Page 2

N S T R U C T I O N S F O R

O N S E N T O F

A Y O R

NOTE: Complete the section below if you made none or only some of the payments to be refunded.

Line 1. Enter the full name of the payer (the individual or entity whose name appears on the check) making the payment to be refunded. If the

payee is a partnership or corporation, enter the full name of the entity.

Line 2. If the payer is a partnership or corporation, enter the name and telephone number of the partner or officer signing this consent. If the

payer is represented by an attorney, trust or other entity, enter the name of the individual signing this consent and attach a Power of

Attorney, court order or other documentation of the representative's capacity.

Line 3. Sign. If the payer is not an individual, the person whose name appears on line 2 must sign this form.

Line 4. Enter the full address of the party signing this form.

Line 5. Have this form notarized and dated.

CONSENT

(not required if the payer is a mortgage holding bank)

Name of payer

Name of partner, corporate officer or legal representative of the payor, if applicable

Telephone number

I am the payer, or an officer, partner or legal representative of the payer, of a tax or charge upon which this claim is based. I have read this claim for

refund or transfer of credit and acknowledge that, to the best of my knowledge, it is true and correct. If the City of New York verifies that an overpayment

exists for this claim, I consent that the refund be paid to the applicant, and I release the City of New York from any claims arising from this refund.

Signature of payer (see instructions)

AFFIDAVIT

4. Sworn to and subscribed to before me on this

______ day of _______________ 19 _______

State of ______________________________

Address

County of _____________________________

Signature of Notary

Stamp or Seal