Form Rp-459 - Application For Partial Exemption For Real Property Of People Who Are Physically Disabled

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RP-459 (1/95)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
APPLICATION FOR PARTIAL EXEMPTION FOR REAL
PROPERTY OF PEOPLE WHO ARE PHYSICALLY DISABLED
(General information and instructions for completing this form are contained in Form RP-459-INS)
l.
Name and telephone no. of owner(s)
2. Mailing address of owner(s)
Day No. (
)
Evening No. (
)
E-mail address (optional)
3. Location of property (see instructions)
_______________________________________
__________________________________________
Street address
Village (if any)
_______________________________________
__________________________________________
City/Town
School District
Property identification (see tax bill or assessment roll)
Tax map number or section/block/lot:
SECTION 1:
4.
Is the property a one, two or three family residence?
Yes
No
Does a disabled person reside in the residence?
Yes
No
If answer to either question is no, do not complete the remainder of this form.
Property is not eligible for exemption.
5. Name of disabled person:
Relationship to owner of property:
6. Description of nature of disabled person’s permanent physical impairment which substantially limits one or
more major life activities (e.g. walking):
7. Description of improvement to property:
8. Date of completion of improvement:
9. Cost of improvement:
IF DISABLED PERSON IS LEGALLY BLIND, ATTACH CERTIFICATE FROM STATE COMMISSION FOR THE
BLIND AND VISUALLY HANDICAPPED AND ANSWER QUESTION 10, OR HAVE PHYSICIAN COMPLETE
SECTION 2. IF DISABLED PERSON IS SUFFERING FROM A PERMANENT PHYSICAL DISABILITY OTHER
THAN BLINDNESS, HAVE PHYSICIAN COMPLETE SECTION 2 AND DO NOT ANSWER QUESTION 10.
10. Explain how improvement facilitates and accommodates disabled person’s use and accessibility of residence.
I certify that all statements made above are true and correct.
Signature of Owner (or Owner’s Representative*)
Date
*If owner is physically unable to complete this form, it may be completed by the owner’s spouse, child or parent, or
by some other representative of the owner. Explain representative’s relationship to the owner.

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