Page 2 of 2 RP-458 (1/16)
4 Of the eligible funds listed in line 3, specify below the amounts, if any, which were used in the purchase of real property:
Full purchase price of property .......................................................................................................... $
Amount of down payment (if any) ...................................................................................................... $
Amount of purchase money mortgage given or assumed at the time of purchase ............................ $
Paid to Date paid
Improvements to property .................................................................................................................. $
Paid to Date paid
Paid to Date paid
Total amount of eligible funds used in the purchase of the property
(add lines 2, 3, and 4) .................. $
5 Is the owner claiming a total exemption pursuant to Section 458(3) of the Real Property Tax Law
(eligibility for or use of federal funds to acquire a residence with special xtures or facilities made
necessary by a veteran’s disability? .......................................................................................................................... Yes No
If Yes, enter the name of the School District ...........................................................................................
If Yes, attach proof of the eligibility for or monies received from the United States government.
6 Has the owner(s) ever received or is the owner(s) now receiving an alternative veterans exemption on
property in New York State? ...................................................................................................................................... Yes No
If Yes, year rst granted year last granted .
Location of property of County, State of New York.
The property was exempt for which of the following purposes:
County City/Town Village
7 Is this application made for the purposes of reobtaining a previously granted eligible funds exemption
which will be subject to a local change in level of assessment
(see instructions) ........................................................ Yes No
Certication
I (we) hereby certify that all the statements made on this application are true and correct to the best of my (our) knowledge and belief
and I (we) understand that any willful false statement made herein will subject me (us) to the penalties prescribed therefore in the Penal
law.
State of New York, County of Signature of owner or authorized representative
, being duly sworn, deposes and says that the statements contained in this
application are true to the best of his or her knowledge.
Subscribed and sworn to me this day of 20
Commissioner of deeds or notary public
This Area for Assessor’s Use Only
Application approved:
Amount of eligible funds: $
Amount of exemption: $
Application denied:
Assessor’s name
Assessor’s signature Date
