RP-483-d (9/08)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
APPLICATION FOR REAL PROPERTY TAX EXEMPTION
FOR FARM OR FOOD PROCESSING LABOR CAMPS OR COMMISSARIES
Do not file this form with the Office of Real Property Tax Services
A separate application must be filed for each parcel.
Read information and instructions for filing on back of this form.
1.
Name and telephone no. of owner(s)
2. Mailing address of owner(s)
____________________________________
________________________________________
____________________________________
________________________________________
Day No. (
) _______________________
________________________________________
Evening No. (
)____________________
E-mail (optional __________________________
3.
Parcel location
____________________________________
________________________________________
Street address
Village (if any)
____________________________________
________________________________________
City/Town
School district
Parcel identification (see tax bill or assessment roll)
Tax map number or section/block/lot _______________________________________________________
4.
Structures for which tax exemption is claimed:
Number of structures
Farm labor camp
_________________
Farm labor camp commissary
_________________
Food processing labor camp
_________________
Food processing labor camp commissary
_________________
5.
Attach to the application a copy of:
a. a State Sanitary Code permit to operate a migrant farm worker housing facility;
b. a State Labor Department farm labor certificate of registration, permit to operate a farm labor camp
commissary, and/or migrant labor registration certificate; and
c. proof of compliance with the fire prevention and building code, such as a copy of the certificate of
occupancy, a statement from the code enforcement officer that the structure has not been determined
to be in violation of the code, and/or a statement from the code enforcement officer that the code does
not apply to the structure.
I, _________________________________, hereby certify that the information provided on this application
constitutes a true statement of the facts to the best of my knowledge.
___________________________________________
___________________________
___________________________________________
___________________________
Signature of owner (s)
Date
PENALTY FOR FALSE STATEMENTS
A person making false statements on an application for exemption is guilty of an offense punishable by law.