Form Rp-6361-App - Application For Mohawk Valley And Niagara County Assessment Relief Act Page 2

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RP-6361-APP (4/14) (back)
6. Please describe in detail the damage to the improvements on the property caused by severe storms in the
Mohawk Valley and Niagara County area and the condition of the property following the storm. Please attach any
supporting documentation.
I certify that all statements made on this application are true and correct to the best of my knowledge and belief, and
I understand that the making of any willful false statement of material fact herein will subject me to the provisions of
the Penal Law relevant to the making and filing of false instruments.
Date
Signature of owner (or representative)
Clear Form

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