REQUEST FOR WAIVER FROM ELECTRONIC FILING  
                                          AND REQUEST TO FILE A PAPER STATEMENT  
                         REAL PROPERTY INCOME AND EXPENSE 2022 (RPIE-2022) AND/OR STOREFRONT REGISTRY FORM  

      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 3, 2023.

                    If approved for a waiver from electronic filing, circle which paper form you will need: 
        RPIE-2022 with Storefront Registry                       RPIE-2022 ONLY                               Storefront Registry ONLY 

This application is a request for a waiver from the electronic filing requirement, allowing for the completion and filing of the paper RPIE-2022 
with Storefront Registry, or RPIE-2022 only, or Storefront Registry only, pursuant to §11-208.1 of the Administrative Code of the City of New York 
You may file this application if: 
 (i)  you are required to file any of the forms listed above; and 
 (ii) you are a senior citizen or have a disability; and 
 (iii) you are the owner of the property(ies) and cannot file any of these forms electronically. 
This application may be used only if you are filing for 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 nine or fewer properties: 
      ❑ I have a disability and it is difficult for me to complete the form electronically. 
      ❑ I am a senior citizen and it is difficult for me to complete the form electronically. 
 
2a. Owner’s Name:  _____________________________________________________________________________________________ 
   b. Owner’s Employer Identification Number:                                          c. Owner’s Social Security Number: 
                                                                     OR
 
    d. Additional Owner’s Name: _____________________________________________________________________________________                               
   e. Additional Owner’s Employer Identification Number:                               f. Additional Owner’s Social Security Number: 
                                                                     OR
 
   g. Additional Owner’s Name: _____________________________________________________________________________________                                
   h. Additional Owner’s Employer Identification Number:                               i. Additional Owner’s Social Security Number:
                                                                     OR

 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 nine or fewer lots, please indicate if this filing covers      :
 
     a. ❑ Condominium lot range from lot ______________       to lot ______________ 
 
     b. ❑ 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-2022-WAIVER REQ  1.19.2023

Application for Waiver from Electronic Filing and Request to File a Paper Statement                Page 2

 PART II: BASIS FOR WAIVER REQUEST
The Department of Finance may, for good cause, waive the electronic filing requirement for RPIE-2022 with Storefront Registry, 
or RPIE-2022 only, or Storefront Registry only, and accept a paper format.  Please state the reason(s) for your request to waive 
the electronic filing requirement for RPIE. The Department of Finance will let you know if your Request for Waiver has been 
granted. 
 
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         PART III: CERTIFICATION

 I hereby certify that I am the owner. I certify that all information contained in this Waiver Application is true 
 and correct to the best of my knowledge and belief. I understand that the willful making of any false state-
 ment of material fact herein will subject me to the provisions of law relevant to the making and filing of 
 false instruments and will render this Waiver Application null and void.            

         ____________________________________________ ________________________________________ _______________________ 
         Signature                                    Name (print)                             Date

                                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 So-
 cial 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 pro-
 cessing 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 Num-
 bers, may be further disclosed to other departments or agencies, or to persons employed by such de-
 partments or agencies, only for such purposes, or as otherwise provided by law or judicial order.