Lien Sale Property Exemption Application - New York City Department Of Finance
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1
2NEW YORK CITY DEPARTMENT OF FINANCE
PROPERTY EXEMPTION ADMINISTRATION DIVISION
LIEN SALE PROPERTY EXEMPTION APPLICATION
l
One- to three family homes and residential condos will not be included in future lien sales if they qualify for one of the following: a Senior Citi-
zen, Disabled Homeowner, Combat Veteran or Disabled Veteran exemption. In addition, they will not be included in future lien sales if they are
eligible as a result of filing a “Military Personnel Application” or if they receive the NYS Property Tax Credit (Circuit Breaker) for tax year 2016.
Please mail this application within 20 days of receipt with ALL REQUIRED DOCUMENTS to:
NYC Department of Finance, P.O. Box 311, Maplewood, NJ 07040-0311
DOF will notify you whether or not you have been approved or denied for any exemptions.
Please check the box of each exemption you are requesting and complete the corresponding sections:
q
q
q
q
q
Senior
Disabled
Veteran
Military Active Duty
Circuit Breaker Credit
Sections 1, 2, 3, 7
Sections 1, 2, 3, 7
Sections 1, 2, 4, 7
Sections 1, 2, 5, 7
Sections 1, 2, 6, 7
SECTION 1 - PROPERTY INFORMATION
Address _________________ ___________________________________________________
_______________
HOUSE NUMBER
STREET NAME
APARTMENT NUMBER
Your property’s BBL can be found on the notice re-
Borough
_____________________
_________________ _______________
ceived with this form or at
Block
Lot
BOROUGH
BLOCK
LOT
SECTION 2 - OWNER INFORMATION
Owner #1 _______________________________________
____________________________________________
FIRST NAME
LAST NAME
Social Security #:
Date of Birth:
Phone:______________________
MM
DD
YYYY
YES
NO
Email:_____________________________________________
Is this your Primary Residence?
n
n
Owner #2 ______________________________________
____________________________________________
FIRST NAME
LAST NAME
Social Security #:
Date of Birth:
Phone:______________________
MM
DD
YYYY
YES
NO
Email:_____________________________________________
Is this your Primary Residence?
n
n
Indicate your relationship between owners:_______________________________________________________________________
If there are more than two owners, please attach a sheet detailing Owner Information for each additional owner.
SECTION 3 - SENIOR CITIZEN & DISABLED HOMEOWNER’S EXEMPTIONS ELIGIBILITY
Question 1
YES
NO
Did any of the owners file taxes in 2015?
If you checked YES, please submit the following REQUIRED documents:
□ Copies of 2015 Federal tax returns and schedules/attachments for all owners.
□ If any owner was not required to file in 2015, please submit proof of earnings for 2015 (copies of W-2 forms, 1099
forms, etc.) Please write the names of all owners NOT required to file in 2015 and reason why.
Owner: _____________________________________
Reason:______________________________________
Owner:_____________________________________
Reason:______________________________________
If there are more than two owners that didn't file, please attach a sheet with the additional owners' names and reasons why.
Question 2
YES
NO
Do any of the owners, their spouse or registered domestic partner receive any disability income,
such as: Social Security Disability Insurance, Supplemental Security Income, Railroad Retirement Dis-
ability Benefits or a Disability Pension?
If you checked YES, please submit at least ONE (1) of the following REQUIRED documents:
□ Copy of the award letter from the Social Security Administration, Railroad Retirement Board or
the U.S. Postal Service OR the State Commission for the Blind and Visually Handicapped
Lien Sale Exempt. Appl. Rev. 03.16.2017
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