Form Rp-467-Aff/ctv - Affidavit Of Continued Eligibility For County/city/town/village Partial Tax Exemption For Real Property Of Senior Citizens

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RP-467-aff/ctv
Department of Taxation and Finance
Office of Real Property Tax Services
Affidavit of Continued Eligibility
(7/16)
For County/City/Town/Village
Partial Tax Exemption for Real
Property of Senior Citizens
State of New York:
County:
, 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 Mailing address:
Telephone number
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 the last year is not more than the maximum income allowed by the following
municipalities (Mark an X in the appropriate box(es) if your total income last year was more than the maximum
amount allowed by that municipality; see instructions):
County
City/Town
Village
Certification
Subscribed to and sworn to before me, this
day of
, 20
.
Signature of Owner
Commissioner of deeds or notary public
Signature of Owner

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