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RP-467

(7/18)

Department of Taxation and Finance

Ofce of Real Property Tax Services

Application for Partial Tax Exemption for

Real Property of Senior Citizens

For help completing this application, see Form RP-467-I, Instructions for Form RP-467. You must le this application with your local

assessor by the taxable status date. Do not le this form with the Ofce of Real Property Tax Services.

New for 2019. This form no longer serves as the application for the Enhanced STAR exemption. This form may only be used to

apply for the partial tax exemption for real property of senior citizens. It may not be used to apply for the Enhanced STAR exemption,

which is a separate exemption.

To apply for the Enhanced STAR exemption, you must le Forms RP-425-E, Application for Enhanced STAR Exemption for

the 2019-2020 School Year, and RP-425-IVP, Supplement to Forms RP-425-E and RP-425-Rnw, with your assessor by taxable

status date. You may obtain those forms from your assessor or download them from www.tax.ny.gov. Note: If you do not already have

a STAR exemption you may not apply for a new STAR exemption, but you may be eligible for a STAR credit, which is provided in the

form of a check. For more information about the STAR credit, visit www.tax.ny.gov/STAR or call 518-457-2036.

Name(s) of owner(s)

Mailing address of owner(s)

(number and street or PO box) Location of property (street address)

City, village, or post ofce State ZIP code City, town, or village State ZIP code

Daytime contact number Evening contact number School district

E-mail address

Tax map number of section/block/lot: Property identication (see tax bill or assessment roll)

Name(s) of any non-owner spouse(s)

Address(es) of primary residence(s) if different from above:

1 Indicate which documents you included with this application as proof of age of owners (see instructions):

Driver license Birth certicate Other (specify)

2 Date you acquired ownership of property

(see instructions):

3 Indicate document included with application as proof of ownership

(see instructions):

Deed Other (specify)

4 Do all the owners of the property presently occupy the premises as their legal primary residence? ...................... Yes No

4a If the answer to 4 is No, is an owner receiving medical care as an in-patient in a residential

health care facility? ........................................................................................................................................ Yes No

4b If the answer to 4a is Yes, specify name and location of the facility:

4c If the answer to 4 is No, is the non-resident owner the spouse or former spouse of the resident owner? .... Yes No

4d If the answer to 4c is Yes, is he or she absent from the residence due to divorce, legal separation,or

abandonment? ........................................................................................................................................ Yes No

5 Is any portion of the property used for other than residential purposes (commercial, professional ofce, etc.)? ... Yes No

5a If answer is Yes, explain such use and describe the portion that is so used.

Page 2 of 3 RP-467 (7/18)

6 List the income of each owner and spouse of each owner for the calendar year immediately preceding date of application. Attach

additional sheets if necessary.

(See instructions for income to be included.)

7 Of the income specied in line 6c how much, if any, was used to pay for an owner’s care in a

residential health care facility? Attach proof of amount paid: enter 0 if not applicable.

(see instructions) ............................................................................................................................ 7

7a Total income of owner(s) and spouse(s) (subtract line 7 from line 6c) ................................ 7a

8 If a deduction for unreimbursed medical and prescription drug expenses is authorized by any

of the municipalities in which the property is located (see instructions), complete the following:

8a Unreimbursed medical and prescription drug costs

(deduct any amounts reimbursed by

insurance). ............................................................................................................................. 8a

8b Total income of owner(s) and spouse(s) (subtract line 8a from line 7a) .............................. 8b

9 If a deduction for veteran’s disability compensation is authorized by any of the municipalities

in which the property is located, complete the following

(see instructions):

9a Veteran’s disability compensation received (attach proof, enter 0 if not applicable) ........... 9a

9b Total income of owner(s) and spouse(s) (subtract line 9a from line 8b) .............................. 9b

Name of owner(s) Source of income Amount of income

Name of spouse(s) if not owner of property Source of income of spouse(s) Amount of income of

spouse(s)

6b Total income of spouse(s) .................................................................................................... 6b

6c Total income of owner(s) and spouse(s) (add line 6a and line 6b) ...................................... 6c

6a Total income of owner(s) ..................................................................................................... 6a

10 Did the owner or spouse le a federal or New York State income tax return for the preceding year? .................... Yes No

If answer is Yes, attach copy of such return or returns

(see instructions).

11 Does a child (or children), including those of tenants or lessees, reside on the property and attend a

public school, grades pre-K through 12? ................................................................................................................. Yes No

11a If the answer to 11 is Yes, list name and location of school(s):

11b If the answer to 11 is Yes, was the child (or were the children) brought into the residence in whole or in

substantial part for the purpose of attending a particular school within the school district? ............................ Yes No

RP-467 (7/18) Page 3 of 3

I (we) certify that all statements made on this application are true and correct to the best of my (our) belief and I (we) understand that

any willful false statement of material fact will be grounds for disqualication from further exemption for a period of ve years, and a ne

of not more than $100.

Signature

(If more than one owner, all must sign)

Marital status Phone number Date

This Area for Assessor’s Use Only

Date application led

Proof of age submitted

Proof of ownership submitted

Proof of income submitted

Application approved

Application disapproved

Exemption applies to taxes levied by or for:

Town %

County %

School %

Village %

Assessor’s signature Date

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