Fillable Receiver-rp923 Form RP-923:1/95:Requst for Mailing of Duplicate Tax Bills or Statements of Upaid Taxes to a Third Party:rp923

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Receiver-rp923 Form RP-923:1/95:Requst for Mailing of Duplicate Tax Bills or Statements of Upaid Taxes to a Third Party:rp923

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The Receiver-rp923 Form RP-923:1/95:Requst for Mailing of Duplicate Tax Bills or Statements of Upaid Taxes to a Third Party:rp923 form is 2 pages long and contains:

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U.S.A. forms for Town of Bedford

BROWSE TOWN OF BEDFORD (NY) FORMS

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RP-923 (1/95)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
REQUEST FOR MAILING OF DUPLICATE TAX BILLS
OR STATEMENTS OF UNPAID TAXES TO A THIRD PARTY
Mail to:
(Tax Collecting
Officer's Name
and Address)
I request that a duplicate of any tax bill or statement of unpaid taxes with respect to my property as
described below be mailed to the person whom I have designated. In making this request I understand that
neither the tax collecting officer nor any other local government employee has any liability if for any
reason the duplicate is not mailed to or not received by my designee.
I am:
At least 65 years of age or Disabled
If disabled, have physician complete back of this form, or if applicant is legally blind, you may substitute
a certificate from the State Commission for the Blind.
_________________________________________________________________________
1.
Your name (last name first)
_________________________________________________________________________
2.
Mailing address Zip code
_________________________________________________________________________
3.
Property Identification no. (see tax bill or assessment roll)
_________________________________________________________________________
4.
Tax billing address (if different from #2, above)
5. __________________________________________ _________________________
Signature Date
THIS SECTION TO BE COMPLETED BY THIRD PARTY
_________________________________________________________________________
1.
Third party name (last name first)
_________________________________________________________________________
2.
Mailing address
_________________________________________________________________________
Zip code
________________________________ 3. ________________________________
Day telephone no. Evening telephone no.
4. _______________________________________ __________________________
Third party signature Date
RP-923 (1/95)
NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE
OFFICE OF REAL PROPERTY TAX SERVICES
PHYSICIANS' CERTIFICATION FOR APPLICATIONS MADE ON BEHALF OF
AGED OR DISABLED PERSONS
___________________________________ __________________________ ___________________
Physician's name New York State license no. Date of issue
Physician’s office address: ________________________________________
______________________________________________________________
______________________________________________________________
Patient’s name: ________________________________________________
Patient’s address: ________________________________________________
______________________________________________________________
______________________________________________________________
Does patient have a physical or mental impairment which substantially limits one or more major life activities
(e.g., walking)?
Yes No
Describe: _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I certify that all statements made in this section are true and correct to the best of my knowledge and
professional belief.
_____________________________ _______________________________________
Date Signature of Physician
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Receiver-rp923 Form RP-923:195:Requst for Mailing of Duplicate Tax Bills or Statements of Upaid Taxes to a Third Party:rp923

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Completed 11 July 2020

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