Form Rp-421-O - Application For Partial Tax Exemption For Capital Improvements To Multiple Dwelling Buildings In Certain Cities

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RP-421-o

Department of Taxation and Finance

Office of Real Property Tax Services

Application for Partial Tax Exemption for

(1/17)

Capital Improvements to Multiple Dwelling

Buildings in Certain Cities

For help completing this form, see the instructions on page 3. Attach additional sheets if necessary.

Name(s) of owner(s)

Mailing address of owner(s)

Location of property

(number and street or PO Box)

(street address)

City, village, or post office

State

ZIP code

City, town, or village

State

ZIP code

Daytime contact number

Evening contact number

School district

Email address

Tax map number of section/block/lot: Property identification

(see tax bill or assessment roll)

1 a) Date title to multiple dwelling was acquired by owner ..........................................................................................

b) Date owner occupied property .............................................................................................................................

c) Property for which exemption is sought has been converted from a multiple dwelling to an

owner-occupied single family residence? ............................................................................................................ Yes

2 a) Square footage of residence without improvement .........................................................................

square feet

b) Square footage of residence with improvement ...............................................................................

square feet

c) As measured by square footage in question 5b, is more than one-half of the residence

at least five years old? ......................................................................................................................................... Yes

3 a) Date of commencement of construction of improvement converting multiple dwelling to single family residence

b) Date completed (attach copy of certification of occupancy or other documentation of completion) ....................

4 Describe the improvement for which exemption is sought. Attach additional sheets if necessary.

5 Cost of improvement. Supply documentation: ......................................................................................................... $