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RP-444-a (9/08)

NYS DEPARTMENT OF TAXATION & FINANCE

OFFICE OF REAL PROPERTY TAX SERVICES

APPLICATION FOR PARTIAL EXEMPTION FOR ALTERATION OR

REHABILITATION OF HISTORIC REAL PROPERTY

(General information and instructions for completing this form are on back.)

1. Name and telephone no. of owner (s)

2. Mailing address of owner(s)

_______________________________________

________________________________________

_______________________________________

________________________________________

Day no. (

) __________________________

________________________________________

Evening no. (

) _______________________

________________________________________

E-mail (optional) _________________________________________________________________________

3. Location of property

Street address ____________________________________________________________________________

Village (if any) ________________________________

City/Town _______________________________

School district

__________________________________________________________________________

Parcel identification no. (see tax bill or assessment roll)

Tax map number or section/block/lot _________________________________________________________

4. General description of property: _____________________________________________________________

_______________________________________________________________________________________

5. Use(s) of property: ________________________________________________________________________

6a. Date construction of alteration or rehabilitation was commenced: ___________________________________

b. Date completed (attach certificate of occupancy or other documentation of completion): _________________

7. Cost of alteration or rehabilitation: _______________________________

8. Describe how alteration or rehabilitation made to property accomplishes the purposes of historic preservation:

_______________________________________________________________________________________

9. Attach proof of landmark or historic district designation. For property in a historic district, explain how

property contributes to the district’s historic character: ___________________________________________

_______________________________________________________________________________________

10. Attach approval of local preservation commission for alteration or rehabilitation.

I certify that all statements made above are true and correct.

_____________________________________

_______________________

Signature of Owner

Date

Form Rp-444-A - Application For Partial Exemption For Alteration Or Rehabilitation Of Historic Real Property