RP-923 (1/95)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
REQUEST FOR MAILING OF DUPLICATE TAX BILLS
OR STATEMENTS OF UNPAID TAXES TO A THIRD PARTY
Mail to:
(Tax Collecting
Officer's Name
and Address)
I request that a duplicate of any tax bill or statement of unpaid taxes with respect to my property as
described below be mailed to the person whom I have designated. In making this request I understand that
neither the tax collecting officer nor any other local government employee has any liability if for any
reason the duplicate is not mailed to or not received by my designee.
I am:
At least 65 years of age or
Disabled
If disabled, have physician complete back of this form, or if applicant is legally blind, you may substitute
a certificate from the State Commission for the Blind.
1.
_________________________________________________________________________
Your name (last name first)
2.
_________________________________________________________________________
Mailing address
Zip code
3.
_________________________________________________________________________
Property Identification no. (see tax bill or assessment roll)
4.
_________________________________________________________________________
Tax billing address (if different from #2, above)
5.
__________________________________________
_________________________
Signature
Date
THIS SECTION TO BE COMPLETED BY THIRD PARTY
1.
_________________________________________________________________________
Third party name (last name first)
2.
_________________________________________________________________________
Mailing address
_________________________________________________________________________
Zip code
3.
________________________________
________________________________
Day telephone no.
Evening telephone no.
4.
_______________________________________
__________________________
Third party signature
Date