Form Rp-425-Tpn - Request For Mailing Of Notice To A Third Party Regarding Senior Citizens Exemption

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RP-467-TPN (08/07)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
REQUEST FOR MAILING OF NOTICE TO A THIRD PARTY
REGARDING SENIOR CITIZENS EXEMPTION
INSTRUCTIONS: A person eligible for the senior citizens exemption (per section 467 of the Real Property
Tax Law) may use this form to request that a notice be sent to an adult third party to assist the senior citizen
fulfill the eligibility requirements regarding the exemption.
This form must be submitted to the assessor of the assessing unit in which the senior citizen resides no later
than 60 days before the taxable status date in your municipality.
THIS SECTION TO BE COMPLETED BY
RECIPIENT OF THE SENIOR CITIZENS EXEMPTION
1.
Your Name
2.
Mailing Address
Zip Code
3.
Property Identification No. (see tax bill or assessment roll)
I request that a notice be mailed to the person whom I have designated below. In making this request I
understand that no state or local government employee has any liability if for any reason the notice is not
mailed to or not received by my designee.
4.
Signature
Date
THIS SECTION TO BE COMPLETED BY THIRD PARTY
1.
Third Party Name
2.
Mailing Address
Zip Code
3.
Day Telephone No.
Evening Telephone No.
4.
Third Party Signature
Date
Clear Form

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