Form Rpie-2013-Waiver - Real Property Income And Expense (Rpie) Statement

REAL PROPERTY INCOME AND EXPENSE (RPIE) STATEMENT 2016

APPLICATION FOR WAIVER FROM ELECTRONIC FILING OF RPIE AND

REQUEST TO FILE A PAPER RPIE STATEMENT

Mail Waiver Application to: NYC Department of Finance, RPIE Unit, 66 John Street, 12th Floor, New York, NY 10038

Waiver application must be postmarked by May 2, 2017.

Instructions - This application is a request for waiver of the electronic filing requirement and to allow for the completion of the

the paper format of Form RPIE-2016 (RPIE-2016-A) pursuant to §11-208.1 of the Administrative Code of the City of New York.

Who may file this application - You may complete this application if:

(i) you are required to file Form RPIE-2016; and

(ii) you are a senior citizen or have a disability; and

(iii) you are the owner of the property(ies) and cannot file Form RPIE-2016 electronically.

This application may be used only if you are filing for 9 (nine) or fewer properties. All other filers must file electronically.

PART I: OWNER AND PROPERTY INFORMATION

SECTION A - OWNER INFORMATION

1. Please check all that apply if you are the owner of the property(ies) and you are filing for 9 (nine) or fewer properties:

❑

I have a disability and it is difficult for me to complete the RPIE electronically.

❑

I am a senior citizen and it is difficult for me to complete the RPIE electronically.

2a. 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:

g. Additional Owner’s Name: _____________________________________________________________________________________

h. Additional Owner’s Employer Identification Number:

i. Additional Owner’s Social Security Number:

SECTION B - CONTACT INFORMATION

1. Contact Name:______________________________________

2. Firm Name:___________________________________________

3. Contact Address:____________________________________

(

)

ADDRESS WHERE WAIVER REQUEST DETERMINATION IS TO BE MAILED

4. Telephone #: ______________________________________

5. E-mail Address (if any): _________________________________

6. Address of Property: ________________________________

7. Borough: ________________________________

b. Block: __________________________

c. Lot:___________________

8. Individual condominium unit owners filing for 9 (nine) or fewer lots, please indicate if this filing covers:

Condominium lot range from lot ______________ to lot ______________

❑

All lots within a range from lot ______________ to lot ______________;

from lot ______________

to lot ______________

❑

from lot ______________ to lot ______________;

from lot ______________

to lot ______________

from lot ______________ to lot ______________;

from lot ______________

to lot ______________

RPIE-2013-WAIVER REQ 01.13.2017

Form Rpie-2013-Waiver - Real Property Income And Expense (Rpie) Statement - 2016

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