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Exemption Application For Owners EX-01 - New York
| Exemption Application For Owners Form. This is a New York form and can be used in Department Of Finance City Of New York New York Local County . |
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TM This application is for the following exemption programs for your New York City primary residence: Basic and Enhanced STAR (School Tax Relief), Senior Citizen, Disabled, Veteran and Clergy. Please read the instructions at the end of this application before you fill it out. If you have questions, contact 311. Finance EXEMPTION APPLICATION FOR OWNERS NEW YORK CITY DEPARTMENT OF FINANCE G PROGRAM OPERATIONS DIVISION 2013/2014 Please check the box of each exemption you are requesting: STAR SECTION 1 - PROPERTY INFORMATION Sections 1, 2, 4 & 8 Applications must be postmarked by March 15, 2013 to be eligible for the 2013/14 tax year. K Enhanced STAR Sections 1, 2, 3, 4 & 8 K Senior Sections 1, 2, 3, 4 & 8 K Disabled Sections 1, 2, 4, 5 & 8 K Veteran Sections 1, 2, 6 & 8 K Clergy Sections 1, 2, 7 & 8 K 1. Address: 2. Type of Residence (check one): Date you purchased the property: ______________________________ ________________ Block: BOROUGH ZIP CODE DD MM YYYY _______________ HOUSE NUMBER ______________________________________________ STREET NAME YOUR PROPERTYS BLOCK AND LOT CAN BE FOUND AT nyc.gov/finance Lot: _______________ APARTMENT NUMBER SECTION 2 - OWNER INFORMATION If there are more than two owners, please complete the Additional Owners Sheet on page 4. Other (please specify): ___________________ and the percent of space used for primary residence:_______% 3. Management Company/ Agent Contact Information: ______________________________________ Phone # ________________________ 1. Owner #1: ______________________________________ FIRST NAME DD YYYY K K K 1-, 2-, 3-family dwelling Cooperative - Unit # _____________________ and the number of shares: #______________. K Condominium Unit Date of Birth: 2. Owner #2: Email: __________________________________________ Date of Birth: FIRST NAME MM Social Security #: _________________________________________ Phone:______________________ LAST NAME ______________________________________ DD YYYY Is this Owner #1s Primary Residence? 3. Are owners #1 and #2 spouses or siblings? 4. Is there a Life Estate on this property? SECTION 3 - AGE VERIFICATION Email: __________________________________________ MM Social Security #: _________________________________________ Phone:______________________ LAST NAME I YES I NO To apply for a Senior Citizen or Enhanced STAR exemption, you MUST provide a copy of a government-issued ID (e.g., driver's license, passport or birth certificate) for all owners who will be 65 or older by December 31, 2013. I am applying for Senior Citizen or Enhanced STAR and I have included a copy of my government issued ID. SECTION 4 - INCOME INFORMATION I YES I YES I NO I NO If "YES", Owner of Life Estate: _______________________________ I YES I YES EX-01 Rev 10.16.12 Is this Owner #2s Primary Residence? I YES I NO To apply for Basic or Enhanced STAR, Senior Citizen or Disabled exemptions, you MUST provide a copy of the 2011 federal tax return and schedules for all owners. I have included a copies of 2011 federal tax returns for all owners. If any owners do not file a tax return, submit proof of 2011 earnings (Social Security, 1099 forms, W-2) complete the section below. 1. Name: _______________________________________ Reason for not filing: ___________________________________ Senior Citizen and/or Disabled Homeowners: Please attach documentation of any unreimbursed medical or prescription expenses. American LegalNet, Inc. www.FormsWorkFlow.com 2. Name: _______________________________________ Reason for not filing: ___________________________________ PAGE 1 OF 7 Exemption Application for Owners SECTION 5 - DISABILITY INFORMATION SECTION 6 - VETERAN INFORMATION If you checked yes, please submit a copy of one of the following required documents: I Social Security Administration award letter I Railroad Retirement Board or the U.S. Postal Service award letter I State Commission for the Blind and Visually Handicapped certificate 1. Are any of the owners a veteran who served during a period of conflict? Are any of the owners a spouse or unremarried widow/er of a veteran? Are any of the owners a parent of a soldier killed in action? If yes, where did the veteran serve? YES Do any of the owners or their spouse receive any disability income, such as: Social Security Disability Insurance, Supplemental Security Income, Railroad Retirement Disability Benefits or a Disability Pension? YES NO NO If YES, list years of service. Ex: 1965 - 1972 If you checked yes to any box, you MUST submit a copy of the DD-214 or separation papers for each veteran. 2. Did the veteran serve in a combat zone or theater? 3. Was the veteran disabled in the line of duty? If you checked yes, please submit a copy of a letter from the VA documenting the disability rating for each veteran. YES YES NO NO SECTION 7 - CLERGY INFORMATION 1. Are you an active member of the clergy who is primarily responsible for ministerial work? YES NO NO If you are not active: YES 2. Were you unable to perform such work due to an illness or impairment? 3. Are you over age 70? 4. Are you the surviving unremarried spouse of the clergy member? If you checked yes to any box, you MUST submit a verification letter from the employer. In addition, the following documentation is required: I Physicians statement (if you checked yes to # 2) I Copy of a government-issued ID, birth certificate or baptismal certificate (if you checked yes to # 3) I Copy of your marriage certificate and a copy of your spouses death certificate (if you checked yes to # 4) SECTION 8 - SIGNATURES - CERTIFICATION By signing below, I certify that all statements made on this application are true and correct to the best of my knowledge and that I have made no willful false statements of material fact. I understand that this information is subjected to audit and should Finance determine that I do not qualify for tax exemption, I will be disqualified from future exemptions and will be responsible for all applicable taxes due, accrued interest, and the maximum penalty allowable by law. OWNER #1 SIGNATURE: OWNER #2 SIGNATURE: ALL OWNERS MUST SIGN AND DATE THIS APPLICATION, WHETHER THEY RESIDE ON THE PROPERTY OR NOT. ___________________________________________ ___________________________________________ If there are more than two owners, please complete the Additional Owners Sheet on page 4. DATE: ____________________________ DATE: ____________________________ MAILING INFORMATION Mail this completed application and copies of ALL REQU
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