Form Rp-421-I [albany] - Application For Real Property Tax Exemption For Capital Improvements To Multiple Dwelling Buildings Within Certain Cities Page 2

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RP-421-i [Albany] (7/06)
2
Certification
I, _______________________________, hereby certify that the information on this application and any
accompanying papers constitute a true statement of fact.
___________________________________________________
_________________________
Signature of Owner
Date
Clear Form
-----------------------------------FOR ASSESSOR’S USE---------------------------------
1.
Date application filed: ____________________
2.
Applicable taxable status date: ____________________
3.
Action on application: __________Approved
__________Disapproved (Reason):
_____________________________________________________________________________________
4.
Assessed valuation of parcel including improvement: $_______________
5.
Assessed valuation of parcel excluding improvement: $_______________
6.
Assessed valuation of improvement eligible for exemption: $_______________*
(4. minus 5.)
*This figure is the “exemption base” and must be recalculated in any year in which there is a change in
level of assessment of 15 percent.
Percent Amount
Dollar Amount
City
_______%
$____________
_________________________________________________
______________________
Assessor’s signature
Date

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