Senior Citizen Property Tax Exemption Application, Third Party Notification For Real Property Taxes Application Forms
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4Senior Citizen Property Tax Exemption Application
Page 4
O F F I C E
U S E
O N L Y
q
q
Approved...............
Denied.............
Reason:
Reviewer: ______________
Date :___________
_______________________
SECTION 1 - OWNERSHIP / PERSONAL INFORMATION
1. Borough: _____________________________ Block: ______________________ Lot:________________
Address of Property:
____________________________________________________________ Zip Code: __________________
2. Type of residence (check one):
q 1-, 2-, 3-FAMILY HOME
q CONDOMINIUM UNIT
q COOPERATIVE APARTMENT - unit number: ___________
3.
Applicant/Owner
Social Security
Date of
Daytime Phone
Name and Daytime Phone
Name
Number
Birth
Number
Number of Relative or Friend
a. ____________________
_________________
_______
_____________
_________________
b. ____________________
_________________
_______
_____________
_________________
c. ____________________
_________________
_______
_____________
_________________
4. Personal status (check one) (Attach proof of status) (see instructions) :
q SINGLE (includes divorced, unremarried widow or widower)
q LEGALLY SEPARATED
q MARRIED
5. Deed/proprietary lease status (check one) (see instructions for definitions) :
q INDIVIDUAL q HUSBAND/WIFE q JOINT TENANTS q TRUST (Must submit copy of Trust Agreement)
q TENANTS IN COMMON q LIFE ESTATE q SIBLINGS
6. Is the address the legal and primary residence of all of the owners?................................... q YES
q NO
7. Is any owner now in a nursing home or institution?.......................................................... q YES
q NO
If "YES", state owner's name: _____________________________________ Date entered: _______________
Is any person whose name appears on the deed/proprietary lease deceased? ........................... q YES
q NO
8.
If "YES", list name of deceased and attach a photocopy of the death certificate or other proof of death.
________________________________________________________________________________________
9a. Does the present deed/proprietary lease to the property indicate ownership of less than
12 months? ................................................................................................................. q YES
q NO
9b. If "YES", indicate address of previous property: __________________________________________________
_________________________________ Date of purchase: ______________
Date of sale: _____________
10a.Is any other property owned by the applicants? (If "YES", you must complete Section 3.)..... q YES
q NO
10b.Is your residence partially rented? (If "YES", you must complete Section 3.) ...................... q YES
q NO
q NO
11. Is the entire property, listed in item 1 above, used exclusively for residential purposes? .........q YES
If "NO", explain use - Indicate percentage nonresidential: ___________________________________________
_______________________________________________________________________________________
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