RP-1126 (1/98)
New York State Board of Real Property Services
DECLARATION OF INTEREST
Pursuant to section 1126 of the Real Property Tax Law of the State of New York, I hereby
declare that the party identified in Section Two of this Declaration of Interest holds a legally
protected interest in the parcel identified in Section One of this Declaration. I hereby request that the
Enforcing Officer send, to the address specified in Section Four of this Declaration, a copy of any
notice pertaining to such parcel which may be issued hereafter in connection with a tax enforcement
proceeding pursuant to Title Three of Article 11 of the Real Property Tax Law.
Section One. Parcel affected (please print or type):
County:
__________________________________
City or Town:
__________________________________
Owner (s):
__________________________________
Tax Map Number:
__________________________________
Section Two. Name of party holding the interest:
________________________________________
Section Three. Nature of interest (attach copy):
___ Mortgage
___ Lien
___ Other (specify): ___________________________ .
Section Four. Address to which notices should be sent (include name and title of appropriate
officer or employee, if applicable):
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________