Form Rp-421-M - Application For Real Property Tax Exemption For Certain New Or Substantially Rehabilitated Multiple Dwellings Page 2

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RP-421-m (2/12) (back)
7.
Residential attributes of the improvement
a) Is the multiple dwelling occupied or to be occupied as the residence of three or more families living
independently of one another? Yes
No
b) Is any portion of the multiple dwelling used as a hotel? Yes
No
c) Number of dwelling units in building: _____
d) Number of which are affordable dwelling units (see instructions for definition): ______
Attach the report of the municipal agency or officer that verified that the project is in compliance with the
affordable housing requirement. That verification must be done in accordance with procedures established
by the New York State Division of Housing and Community Renewal.
8. Use of property
a. Area of building improvement: _______ square feet
b. Area of building improvement in multiple dwelling use, exclusive of commercial and other uses:
_______ square feet
9. Is the property currently receiving any other exemption from real property taxation? Yes
No
10. Expected date of completion of improvement (attach copy of certificate of occupancy or other
documentation of completion): _____________________
Certification
I, ____________________________________, hereby certify that the information on this application and any
accompanying pages constitutes a true statement of facts.
_____________________________________________
______________________
Signature
Date
For Assessor’s Use
1. Date application filed: ____________
2. Applicable taxable status date: ________________
3. Action on application:
Approved
Disapproved
4. Assessed valuation of parcel in first year of exemption: $ _______________________
5. Increase in total assessed valuation in first year of exemption: $ ______________________
6. Amount of exemption in first year:
Percent
Amount
County
__________________
$ __________________
City/Town
__________________
$ __________________
Village
__________________
$ __________________
School District
__________________
$ __________________
______________________________________________
_________________________
Assessor’s signature
Date
Clear Form

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