RP-467-aff/ctv (8/11)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
AFFIDAVIT OF CONTINUED ELIGIBILITY FOR
COUNTY/CITY/TOWN/VILLAGE PARTIAL TAX EXEMPTION FOR
REAL PROPERTY OF SENIOR CITIZENS AND FOR
ENHANCED SCHOOL TAX RELIEF (STAR) EXEMPTIONS
(see reverse side for general information and instructions)
State of New York
ss:
County of ___________________________
_______________________________________________, being duly sworn, depose(s) and say(s):
(Name of owner(s))
1.
I am/We are the owner(s) of real property located at:
Street Address _________________________________________________________________
Village of __________________________, City/Town of ______________________________
State of New York
2.
Property identification (see tax bill or assessment roll)
Tax map number or section/block/lot ______________________________________________
3.
My/Our post office address is: ____________________________________________________
Telephone no.
Day (
) ______________
Evening (
) ____________________
4.
Since I/we last filed an application or affidavit for this exemption:
a.
there has been no change in the ownership of the property;
b.
there has been no change in marital status of the owners and all of the owners continue to
reside on the property; and
c.
the property continues to be used exclusively for residential purposes.
5.
The income of the owner(s) for last year is not more than the maximum income allowed by the
following municipalities: (Cross out any municipality after a. b. and c. if your total income last
year was more than the maximum amount allowed by that municipality; see back of form for
further instructions.)
a.
County
b.
City/Town
c.
Village
___________________________________
Signature of Owner
___________________________________
Signature of Owner
Subscribed to and sworn to before me, this
________ day of ____________________, 20 __
_________________________________________________
Commissioner of deeds or notary public
Clear Form