Form Rp-7143 - Complaint On Tentative Telecommunications Ceiling Page 4

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RP-7143 (1/15)
Page 4
PART FOUR: CERTIFICATION
I certify that I have read the foregoing complaint and know the contents thereof, that the facts stated therein are
true and correct to the best of my knowledge, information 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 statements.
Date
Signature/Title
Clear Form
This complaint form and supporting documentation must be mailed/served at least ten (10) days before the
hearing date to:
New York State Department of Taxation & Finance
Office of Counsel
W. A. Harriman State Campus
Albany, NY 12227-0911
Please refer to the “Notice of Tentative Telecommunications Ceiling” which specifies the complaint submission
deadline. Specific supporting documentation must be provided in accordance with §499-OOOO of the Real
Property Tax Law. A copy of the complaint form and documentation must be served on each adverse party.
An affidavit of this service must be filed with the Commissioner at the above address on or before the hearing
date.

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