NYS DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
APPLICATION FOR REAL PROPERTY TAX EXEMPTION FOR PROPERTY
HELD IN TRUST BY MEMBERS OF CLERGY FOR
THE BENEFIT OF CHURCH MEMBERS
(See general information and instructions on back of form)
1a. Name of clergy or minister holding title to the property
2. Mailing address of organization
b. Name of organization __________________________
c. Telephone no. of clergy
d. E-mail address (optional) _______________
3. Location of property
Street address ____________________________________________________________________________
Village (if any) ________________________________
Parcel identification no. (see tax bill or assessment roll)
Tax map number or section/block/lot _________________________________________________________
ATTACH COPY OF TRUST INSTRUMENT PURSUANT TO WHICH TITLE IS
CURRENTLY HELD BY CLERGY OR MINISTER NAMED IN ANSWER TO QUESTION 1a.
4. Has the clergy named in answer to question 1a. had formal training as a clergy?
If yes, give details: ________________________________________________________________________
5. Has the clergy been formally ordained?
If yes, state when, where and by whom such clergy was ordained: If no, explain: _______________________
6. Name and address of church of which individual named in answer to question 1a. serves as clergy or minister.
Submit Form RP-420-a-Org (available from assessor) and all attachments required in the form. With respect
to the church named in the answer to question 6 above, submit Form RP-420-a/b-Use (available from assessor).
With respect to the church named in answer to question 6 above, when seeking renewal of exempt status, Forms
RP-420-a/b-Rnw (Parts I and II) may be submitted in lieu of RP-420-a-Org and RP-420-a/b-Use.
State of New York
___________________________________, 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, and correct and complete, and that _he makes this application for real property
tax exemption as provided by law.
Subscribed and sworn to before me
Signature of owner or authorized representative
Commissioner of deeds or notary public