Form Exc-0106 - Application To Remove Previously Granted Exemption(S) (Page 2 of 2) in pdf

Form Exc-0106 - Application To Remove Previously Granted Exemption(S) Page 2

Application to Remove Previously Granted Exemption(s)

Page 2

CONTACT INFORMATION

If we have a question about this application, who should we contact?

Contact Name:__________________________________________________________________________________

(

)

Telephone #:

______

__________________________

Email Address:____________________________________

PLEASE DO NOT FORGET TO ATTACH ALL THE REQUIRED DOCUMENTATION AND TO SIGN AND DATE

THE APPLICATION. FAILURE TO DO SO WILL DELAY THE PROCESSING OF YOUR APPLICATION.

PLEASE KEEP A COPY OF THIS APPLICATION FOR YOUR RECORDS.

PRIVACY ACT NOTIFICATION

The Federal Privacy Act of 1974, as amended, requires agencies requesting Social Security Numbers to inform

individuals from whom they seek this information as to whether compliance is voluntary or mandatory, why the

request is being made and how the information will be used. The disclosure of Social Security Numbers by owners

is mandated by Section 11-102.1 of the Administrative Code of the City of New York. Disclosure by lessees is

voluntary. Disclosure is requested to facilitate the processing of real property income and expense data. Such data,

including any Social Security Numbers so disclosed, are used for tax administration purposes. The data, including

any Social Security Numbers, may be further disclosed to other departments or agencies, or to persons employed

by such departments or agencies, only for such purposes, or as otherwise provided by law or judicial order.

EXC-0106 01.09.2017

Form Exc-0106 - Application To Remove Previously Granted Exemption(S) Page 2