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RPIE-2016

FILING DEADLINE: JUNE 1, 2017

CoNFIDENtIAL

REAL PRoPERtY INCoME AND EXPENsE FoRM

Adult Care and Nursing home Facilities

Check Your Mailing Address: All owners must maintain a current mailing address for each prop-

erty with the NYC Department of Finance. To check your mailing address for this property, look at

the latest Property Tax Bill found. Mailing addresses can be updated online or by calling 311.

Address of Property: ____________________________________________________________________________________________

Borough:________________________________________

Block:_______________________

Lot:________________________

sECtIoN A - owNER/FILER INFoRMAtIoN

1a. Owner’s Name: _____________________________________________________________________________________________

b. Owner’s Employer Identification Number:

c. Owner’s Social Security Number:

d. Additional Owner’s Name: _____________________________________________________________________________________

e. Additional Owner’s Employer Identification Number:

f. Additional Owner’s Social Security Number:

2a. Name of Entity Filing (if different from the owner):___________________________________________________________________

b. Filer’s Employer Identification Number:

c. Filer’s Social Security Number:

d. Entity’s Relationship to the Property:

Owner

Lessee

Owner Representative

Lessee Representative

❑

sECtIoN B - CoNtACt INFoRMAtIoN

1. Contact Name:_____________________________________

2. Firm Name:___________________________________________

3. Address:____________________________________________________________________________________________________

NUMBER AND STREET

City:______________________________________________

State:_____________

Zip Code:_________________________

4. Telephone #: ______________________________________

5. E-mail Address: _______________________________________

sECtIoN D - RPIE EXCLUsIoNs

to be completed only if you are not required to File an RPIE for tax Year 2016.

I am not required to file a RPIE for this year because my property:

has an Actual Assessed Value of $40,000 or less.

❑

is exclusively residential with 10 or fewer apartments.

❑

is primarily residential with 6 or fewer apartments and no more than one commercial unit, and is in tax Class 1 or tax Class 2.

❑

is a residential cooperative apartment building with less than 2,500 square feet of commercial space (not including garage space).

❑

is an individual residential unit that was sold and is not owned by the sponsor.

❑

is rented exclusively to a related person or entity.

❑

is occupied exclusively by the owner but is not a department store with 10,000 or more gross square feet; hotel or motel;

❑

parking garage or lot; power plant; or other utility property; selfstorage warehouse; gas station; car wash or theater.

is owned and used exclusively by a fully exempt not-for-profit organization or government entity and generates no rental income.

❑

is vacant or uninhabitable and non-income-producing for the entire year.

❑

is vacant, non-income-producing land.

❑

The owner has not operated the property and is without knowledge of the income and expenses for the entire calendar or fiscal

❑

year of the reporting period.

1.12.2017

Form Rpie-2016 - Real Property Income And Expense Worksheet And Instructions For Adult Care And Nursing Home Facilities Page 13

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