RPTL 730,AUCS 900 (Rev. JULY 2019)PETITIONSMALL CLAIMS ASSESSMENT REVIEWIN COUNTIES OUTSIDE NEW YORK CITY(one petition per parcel)PART IGENERAL INFORMATIONSUPREME COURT, COUNTY OFFiling #Calendar #2. Assessing Unit3. Date of final completion and filing of assessment roll(a) Total(b) Exempt amount(c) Taxable assessed value (3a-3b)4. Date of filing (or mailing) petitionlf applicable, name and address of representalive of owner, if representative is filing application(Owner must complete Designation of Representalive section.)Name of RepresentativeTelephone #7Description of property as it appears on the assessment rollTax Map #SectionBlockLot8. Location of Property (street, Road highway number, and city, town or village)1.5. Name of owner or owners ot property: -A Arro""'Telephone #:6.6ii.o".' American LegalNet, Inc. www.FormsWorkFlow.com PART IIGROUNDS FOR PETITIONASSESSMENT REQUESTEDA. Assessment requesled on lhe complaint form liled with the Board of Assessment ReviewTotal assessmentExempt amount, if anyTaxable assessment123MAXIMUM REDUCTIONB. Calculation of equalized value and maximum reduction in assessment1. t I Property is NoT in a special assessing unit.ASSESSED VALUE + EQUALIZATION RATE2Property lS in a special assessing unit.ASSESSED VALUE - CLASS ONE RATIOEQUALIZED VALUEEQUALIZED VALUElf the EQUALIZED VALUE exceeds $450,000, enter the ASSESSED VALUE hereNlultiply the ASSESSED VALUE by: x.25Enter the result hereThe result is the maximum total assessment request reduction allowableC, I I UNEQUAL ASSESSIVIENTThe total assessment is unequal because the property is assessed at a higher percentage of full (market)value than (check one).I I (a) theaverage ofall other property on the assessment roll, orI l(b) the average of residential property on the assessment rollFull (market) value of property: $-Based on one or more of the following, petitioner believes this property should be assessed at -%of full (market) value:1 . [ ] The latest State equalization rate for the assessing unit in which the property is located (enter latestequalization ratea/")2. [ ] The latest residential assessment ratio for the assessing unit in which the property is located (enterYo)[]Asampleofmarketvaluesofrecentsalespricesandassessmentsofcomparableresidentialproperties on which petitioner relies for objection (list parcels on a separate sheet and attach)4. I I Statements ofthe assessor or other local officialthat property has been placed onthe roll atvo.233. tlresidential assessment ratio:Petitioner believes the total assessment should be reduced to $. This amount maynot be less than lhe total assessment amount indicated in Section A (1), or Section B (3), whicheveris greater. American LegalNet, Inc. www.FormsWorkFlow.com Dt ] EXCESSIVE ASSESSNIENT:'1. [ ] The lotal assessed value exceeds thefull (market) value ofthe propertyTotal assessed value of property: $Complainant believes the total assessment should be reduced to a full value of $Attach list of parcels upon which complainant relies for objection, if applicable.This amount may not be less than the amount indicated in Section A (1), or Section B (3)2.[ ] The taxable assessed value is excessive because of lhe denial of all ora portion ola partialexemption. Specify exemption- (e.9., aged, clergy, veterans, etc).Amount of exemptionclaimed: $Amount granled, if any: $-. This amountmay not be greater than the amount indicated in A (2).lf application for exemption was filed, attach a copy of application to this petitionE1INFORMATION TO SUPPORT THE FULL (market) VALUE CLAIMED (Check One)[ ] Purchase price of property $Dale of purchaseRelationship, if any, between seller and purchaser2. t I lf property has been recently offered for saleWhen and for how longAsking price: $3. I I lf property has been recently appraisedWhenBy Whom4. I I lI buildings have been recently remodeled, constructed, or additional improvements made, stateYear remodeled, conslructed, or additions madeDate commencedDate completedCost: $5. [ ] Amount for which your property is insured: $Name of insurance company and policy number:PART IIILISTING OF TAXING DISTRICTSSCHOOL DISTRICTNames of Taxing Districts1234COUNTYTOWNVILLAGEHow offered:Puroose of aooraisal:Appraised value: $ -6,I]PurchaSepriceofcomparableproperty(ies)recentlysold.$- American LegalNet, Inc. www.FormsWorkFlow.com PART IVDESIGNATION OF REPRESENTATIVE TO FILE PETITIONl,, as petitioner (or officer thereof) hereby designateto act as my representative in any and all proceedingsbefore the Small Claims Assessment Review of the Supreme Court inCounty forpurposes of reviewing the assessment of my real property as it appears on the - year assessment roll of(assessing unit)Signature of OwnerDateI certify that:(a)(b)Theowner has previouslyfiled a complaint required for administrative review ofassessments(c)(d)(e)The property is improved by a one, two orthree family, owner-occupied residential structureused exclusively for residential purposes, and is not a condominium; except a condominiumdesignated as Class 1 in Nassau County or as "homestead" Class in an approved assessingunit.The requested assessment is not lower than the assessment requested on the complaintfiled with the assessor or the Board of Assessment Review.lf the equalized value ofthe property exceeds $450,000, the requested assessment reductiondoes not exceed 25 percent of the assessed value.I will mail, by certified mail, return receipt requested, or deliver in person, within ten days afterthe day of filing this petition with the County Clerk, one (1)copy of this petition to the clerk ofthe assessing unit, or if there by no such clerk, then to the officer who performs thecustomary duties of that official.I will mail by regular mail within 10 (ten) days after the filing of the Petition with the CountyClerk one (1) copy of the Petition to:(1) The clerk of the school district(s)" within which the real property is located, or if therebe no clerk or the name and address cannot be obtained, then to a trustee,(2) The treasurer of the county in which the property is located, and(3) The assessor, or, the chairman of the board of assessors(4) The clerk of the village, where the village has ceased being an assessing unit inaccordance with Real Property Tax law S 1402(3), if the assessmentto be reviewedis on a parcel located within such village.(0I certify that all statements made on this application are true and correct to the best of my knowledge andbelaef, and I understand that the making of any willful false statement of material fact herein will subject meto the provisions ofthe Penal law relevant to the making and filing of false instruments.Signature of owner or representativeCheck here if evening hearing is desiredtr('NOTE: You are not required to file with the Buffalo City School District, the Rochester City School District, the Syracuse CitySchool Oistrict or the Yonkers City School Distract.)PART VELIGIBILITY AND CERTIFICATION American LegalNet, Inc. www.FormsWorkFlow.com