Form Rp-420-A/b-Rnw-I - Renewal Application For Real Property Tax Exemption For Nonprofit Organizations I-Organization Purpose Page 4

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SCHEDULE A
4
RP-420-a/b-Rnw-I (1/95)
4. During the last fiscal year, did the organization, either directly or indirectly, engage in any of the following acts with a trustee, director,
principle officer or creator of the organization, or any organization with which such a person is affiliated:
a. Sale, exchange or leasing of property? ....................................................................
Yes
No
b. Lending of money or other extension of credit? ......................................................
Yes
No
c. Furnishing of goods, services or facilities? ..............................................................
Yes
No
d. Transfer of any part of the organization’s income or assets? ...................................
Yes
No
Clear Form
IF YES ANSWERED TO a, b, c or d ABOVE, ATTACH A DETAILED
EXPLANATION OF THE TRANSACTION(S)
VERIFICATION
State of New York
)
County of
)ss:
)
__________________________________________________, being duly sworn says: that __he is the
___________________ of the applicant organization, that the statements contained in this application (including
the attached sheets consisting of _____ pages) are true, correct and complete, and that ___he makes this
application for real property tax exemption as provided by law.
Subscribed and sworn to me before
this ________day of _________20_____
___________________________________
_____________________________________________
Signature of owner or authorized representative
Commissioner of deeds or notary public

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