RP-1126 (1/98)
New York State Department of Taxation and Finance
Office of Real Property Tax 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):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________