TM                NEW YORK CITY DEPARTMENT OF FINANCE       l   PROGRAM OPERATIONS DIVISION l        REFUNDS UNIT

Department of Finance PROPERTY TAX REFUND REQUEST
                      Mail to: NYC Department of Finance, Refunds Unit, 59 Maiden Lane, 20th Fl., New York, NY 10038
INSTRUCTIONS:         Please read the instructions for further details before completing this form.  Please print all
information and initial any changes that you make on this application.
SECTION I - GENERAL INFORMATION - All information must be provided.

1.   Property Address:  ____________________________________________________________________________________NUMBER AND STREET
                                                         Zip
2.   City: _____________________ State:_____ Code: ________ 3. Borough:_________ Block: ________ Lot(s):__________
4.  q I made a payment on an incorrect property.  If you checked this box, complete the following:
    Incorrect Property:  Borough: _________________ Block:_______________________ Lot:_______________________

5.   Type of Request (Check the applicable choice(s)): q Refund q Apply Credit to Another Property           q Missing/Misapplied Payment
6.   If you checked Refund in # 5, how would you like to receive it? (Check only one box):           q Direct Deposit q Paper Check
7.   If you checked Direct Deposit in #6, complete 7a, b and c.
     a.  ABA or Routing Number:         b:  Bank Account Number:                                                c:  Account Type:
                                                                                                                q Checking       q Savings
8.   If you checked paper check in #6, complete 8a, b and c.

     a.   Make refund check Payable to: ____________________________________________________________________PRINT NAME OR( FIRM IF APPLICABLE)

     b.   Mail the refund check to this address: _______________________________________________________________NUMBER AND STREET APT/FLOOR
     c.   City: _________________________________________ State:_________________ Zip Code: _________________

SECTION II - FILER INFORMATION

1.  Filer’s Name: _________________________________________________________________________________________PRINT FIRST NAME PRINT LAST NAME
2.  Firm Name (if applicable): ____________________________________________________________________________
                                                                               Email
3.  Telephone Number:  (____) _________________ Extension:_________ Address: _______________________________
4.  Please indicate your relationship to the property:
   q Current owner
     Please indicate the date you took ownership of the property: _______ _______/                   _______/
   q Prior owner
     Please indicate the date when you sold the property: _______/_______ _______/
   q Officer of the cooperative management board
   q Representative of the mortgage company or bank that pays the property taxes
                                                                                                Escrow Account/
     Customer Name:  ___________________________________________PRINT FIRST NAME PRINT LAST NAMELoan Number: ________________________
   q Title Company
     Name of Title Company: ______________________________________ Title Number:  ________________________
   q Member of the condominium management board
   q Attorney/legal representative that brought an assessment reduction resulting in credit

     Attorney Name: ___________________________ Attorney Group #: ______ Tax Periods: ____ _____/                     to ____ _____/
   q I am not the attorney/legal representative that brought the action that resulted in the credit, but I have a letter of authorization
     from that attorney/legal representative authorizing me to request this refund.  (Attach a copy of the letter.)
   q Other.  Please explain the nature of your relationship to the property owner (e.g., family member, managing agent,
     executor of estate or trustee, etc.):  ___________________________________________________________________
Visit Finance at nyc.gov/finance                                                                                      REF-01 - Rev. 06.20.2016

Property Refund Request Form                                                                                         Page 2
SECTION III - ACCOUNT CREDIT INFORMATION
   Please check one of the following to indicate the reason for the credit on this account:

   q Overpayment.  Indicate the amount: $_________________________ Date of payment:________/________/________MONTH DAY YEAR
   q Reduction in assessed property value
     q  The reduction is due to a court order. (Please provide a copy of the court order if interest must be paid on the refund.)
   q Abatements or Exemptions
     q  Senior Citizen Rent Increase Exemption (SCRIE)
     q  Disability Rent Increase Exemption (DRIE)
     q  Other (Please explain):_________________________________________________________________________
   q Cancellation of a charge already paid
   q Payment made erroneously
   q Other  (Please explain): ___________________________________________________________________________

SECTION IV - PAYMENT  INFORMATION
Please note that attorneys filing based on reductions in assessed value do not need to complete this section.
   Check one of the choices below to indicate how payment of the charges was made that resulted in the credits.  If you are fil-
   ing this request based on a missing or misapplied payment, you must attach proof of payment. You must also provide
   proof if payment was made by a mortgage company for multiple parcels. Acceptable proof of payment is listed after each choice.

   q Cash or check paid at a Department of Finance Business Center.  Please provide receipt number _______________________
     or attach a copy of receipt.
   q Check mailed.  Please attach a copy of the front and back of the cancelled check.

   q Credit/debit card.  Indicate transaction confirmation number or receipt number: ___________________________
   q Payment made by mortgage company or bank.  Please attach a copy of the front and back of the cancelled check or proof
     of Fedwire payments.  For payments made for multiple properties, you must also provide a disbursement sheet showing
     how payment was to be allocated.

   q Other: __________________________________________________________________________________________

SECTION V - CREDIT OPTION  INFORMATION
Please select one of the following choices in A. ENTIRE REFUND or B. PARTIAL REFUND        to indicate how you want your
credit distributed:
A. q ENTIRE REFUND 
     q I want the entire credit to be refunded to me in the form of a refund check.

     q I want the entire credit to be transferred to the below property, which I also own.  (Please note that credits that result-
       ed from an attorney action generally may not be transferred and must be refunded.)  Please indicate the amount to
       be transferred, the account type to where the money should be transferred (see #3 in the instructions for more infor-
       mation), and the period to which the money should be applied below.

     Borough  _______________________ Block  __________________________ Lot  __________________________
                   AMOUNT                             ACCOUNT TYPE                                 PERIOD

     $___________________________________ _______________________________ _______ _______/                   _______/
     $___________________________________ _______________________________ _______ _______/                   _______/
     $___________________________________ _______________________________ _______ _______/                   _______/
     $___________________________________ _______________________________ _______ _______/                   _______/
                                                                                                   Section V continues on Page 3.

Property Refund Request Form                                                                       Page 3

SECTION V - CREDIT OPTION  INFORMATION - Continued
B. q PARTIAL REFUND 

   q I want $ __________________ of my credit to be transferred to the below parcel, which I own, and the balance to be
     refunded to me in the form of a check.  (Please note that credits that resulted from an attorney action generally may not
     be transferred and must be refunded.)  Please indicate the amount to be transferred, the account type to where the money
     should be transferred (see #3 in the instructions for more information), and the period to which the money should be
     applied below.            
     Borough  _______________________ Block  __________________________ Lot  __________________________
          AMOUNT                                  ACCOUNT TYPE                    PERIOD

     $___________________________________ _______________________________ _______ _______/ _______/
     $___________________________________ _______________________________ _______ _______/ _______/
     $___________________________________ _______________________________ _______ _______/ _______/
     $___________________________________ _______________________________ _______ _______/ _______/

SECTION VI - CERTIFICATION
SIGN HERE IF YOU PAID THE CHARGES FOR WHICH YOU ARE REQUESTING A REFUND
I am the payer of, or an officer of the cooperative management board or a duly authorized employee of the corpora-
tion that paid a tax or charge upon which this request is based.  I certify that all statements made and information
provided, to the best of my knowledge, is true and correct.  If the City of New York verifies that a credit exists for this
property, I consent that the refund be paid to the above-named individual or entity, and I agree to release the City of
New York from any claims arising from this refund and to reimburse the city for any costs resulting from claims aris-
ing from this refund.  Any refund paid is subject to audit and recoupment.  I understand that any willful false state-
ments made herein may subject me to the penalties described in the Penal Law.

____________________________________      ____________________________________      ____________
Signature                                 Print Name                                Date
SIGN HERE IF YOU DID NOT PAY THE CHARGES FOR WHICH YOU ARE REQUESTING A REFUND

I certify that I have been properly authorized by the payer or entity responsible for payment of the tax or charge upon
which this claim is based to request a refund and to accept payment on behalf of such party.  Any refund paid is sub-
ject to audit and recoupment, and I have so advised the party for whom I am making this application.  I certify that all
statements  made  and  information  provided  on  this  application  are  true  and  correct  to  the  best  of  my  knowledge.    I
understand that any willful false statements made herein may subject me to the penalties described in the Penal Law.

____________________________________      ____________________________________      ____________
Signature                                 Print Name                                Date

       TM
                          PROPERTY REFUND REQUEST
Department of Finance
                                      GENERAL INFORMATION
                                            WHO SHOULD FILE
Please complete this form only in the following cases:
n If you have a credit on your property tax account and would like to request a refund (or transfer of funds to another property you own).
n If you paid on a property erroneously and would like the money transferred and/or refunded.
n If you made a payment, but the payment is not reflected on your account.  
Do not use this form if you have a credit on your property account and want it applied to future taxes.  In most cases, Finance would auto-
matically apply credits towards your next property tax bill for the same account.  In general, if the funds have already been applied to future
taxes, you would not receive a refund.
                                                      INSTRUCTIONS
                                            PLEASE READ CAREFULLY

1. Please  provide  all  of  the  information  requested  and  initial 4. Documentation is generally not required when filing this form.
  any changes that you make on this form.  Incomplete appli-           However, if you are filing this form regarding a payment that is not
  cations or those with insufficient documentation may be can-         reflected on your account, you must submit proof of payment.
  celled or returned.                                                  (See Section IV on the form for more information.) In addition,
                                                                       you must provide documentation in the following instances:  
2. Generally, there are two situations that result in a property
  tax credit:                                                          n    Mortgage companies: If payment was made for multiple
                                                                            properties,  a  disbursement  sheet  must  be  provided.
  n Overpayment: This can occur a) if payment was made
                                                                            (Please see Section IV on the form for more information.)    
    twice, b) if payment was made and then an exemption or
    abatement was put on the account, c) if payment was                n    Attorneys: A copy of the authorization letter if you are
    made and then a charge was subsequently cancelled, or                   not the attorney who brought forth the assessed value
    d) if there are excess credits due to the Senior Citizen                change.  In addition, a copy of the court order must be
    Rent  Increase  Exemption  (SCRIE)  or  Disability  Rent                submitted if the reduction in assessed value was a result
    Increase Exemption (DRIE) programs.  In most of these                   of a court order, and interest must be paid on the refund.
    cases, refunds are generally made payable to the prop-                  (See Sections II and III on the form for more information.)             
    erty owner or the entity who paid the taxes during the             n    Lessees: If a refund check should be made payable to the
    periods in which the credits occurred.  
                                                                            lessee, documentation (such as a lease agreement) must be
    You must apply for a refund or a transfer of credits result-            provided showing the entity's relationship to the property.
    ing from overpayments within six years of the date of the
    overpayment  or  credit.  Please  note  that  overpayments         5. As an alternative to filing this form, you may apply for a prop-
    and credits are automatically applied to unpaid taxes.             erty  refund  online  by  visiting  Finance’s  website  at
                                                                       nyc.gov/finance.    (However,  filers  in  #4  who  must  provide
  n Reduction in property’s assessed value: This occurs                documentation as outlined above should file a hardcopy form.)   
    when  an  appeal  is  made  to  the  Tax  Commission  or
    courts  and  results  in  a  reduction  in  the  property’s        6. If your refund is due to an overpayment or misapplied payment,
    assessed value and the amount of tax due.  In these                you may receive your refund via direct deposit.  (Direct deposit
    cases, refunds are generally made payable to the prop-             is not available for other types of refunds.)  If you elect direct
    erty owner (or to the condominium) but mailed to the               deposit, you must provide your bank routing and account num-
    attorney who helped bring about the successful appeal.             ber in Section I of the form.  If you are not sure where to obtain
                                                                       this information, please contact your bank or financial institution.
3. You may transfer credits to another parcel to pay for property      The Department of Finance is not responsible for a lost refund if
  taxes or other property-related charges.  If you are electing a      you enter the wrong account information.  Please check with
  transfer, you must specify how your credits should be trans-         your  financial institution to get the correct routing and account
  ferred in Section V of the form.  The most common account            numbers and to  make sure your direct deposit will be accepted.
  types are listed below for your reference.  Please note that
  some account types may not apply to your property.                   7. For  all  other  questions  regarding  property  refunds  or  this
  n Property Taxes                                                     form, please visit:
  n Shelter Rent Charges                                                             nyc.gov/propertyrefunds
  n Elevator
  n Sign                                                               Mail  your  completed  Property  Refund  Request
  n Business Improvement District (BID)
  n                                                                    Application along with any required documentation to:
    Emergency Repair
  n Rent Stabilization                                                      NYC Department of Finance
  n Sidewalk Repair                                                         Refunds Unit
  n Inspection or Clean-up                                                  59 Maiden Lane, 20th Floor
Note:  SCRIE/DRIE credits may only be applied to property taxes.            New York, NY 10038