Form Rp-420-A/b-Vlg - Application For Real Property Tax Exemption For Property Of Nonprofit Organizations In Villages Using Town Or County Assessment Roll As Basis For Village Assessment Roll

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RP
-420-a/b-Vlg (1/95)
NYS DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
APPLICATION FOR REAL PROPERTY TAX EXEMPTION FOR PROPERTY OF
NONPROFIT ORGANIZATIONS IN VILLAGES USING TOWN OR COUNTY
ASSESSMENT ROLL AS BASIS FOR VILLAGE ASSESSMENT ROLL
(See general information and instructions on back of form)
___________________________________
____________________________________
la. Name of Organization
c. Employer ID No.
___________________________________
____________________________________
d. Name of Contact Person
___________________________________
Day (
)
Evening ( )___ ___
b. Mailing Address
e. Telephone # of Contact Person
2. Did the organization apply within the last 12 months to the town or county assessor for tax exempt status for
property it owns in the village by submitting forms RP-420-a-Org or RP-420-b-Org and RP-420-a/b-Use (or, if
renewal, RP-420-a/b-Rnw-I and RP-420-a/b-Rnw-II)?
Yes
No
3. Was an exemption granted on the last completed town or county assessment roll?
Yes
No
If the answer to question 2 or 3 is no, this form is inappropriate, and the organization must submit forms
RP-420-a-Org or RP-420-b-Org and RP-420-a/b-Use in order to receive exemption.
If the answer to question 2 and 3 is yes, answer question 4, sign certification and submit this form to the
village assessor or village clerk on or before taxable status date.
4. Has there been any change in the organization’s purpose or activities or in the use of any of its property located
in the village since application for exemption was last filed with the town or county assessor?
Yes
No
If yes, explain (attach additional sheets if necessary).
Certification
I hereby certify that the statements contained in this application (including the attached sheets consisting of _____
pages) are true and correct to the best of my knowledge.
_____________________________
______________________
__________________________________
Signature
Date
Title
FOR ASSESSOR’S USE ONLY
Assessing unit _____________________________________
County ________________________________
Town ____________________________________________
Village ________________________________
Parcel Identification No.(s) ____________________________________________________________________
Clear Form

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