RPTL 730-4UCS 900A (Rev. 7/2019)PETITIONSMALL CLAIMS ASSESSMENT REVIEWIN COUNTIES IN NEW YORK CITY(one petition per parcel)PART IGENERAL INFORMATIONSUPREME COURT. COUNTY OFFiling #Calendar #IAssessed valuation2(a) Total(b) Exempt amount(c) Taxable assessed value ('1a-1b)Date of filing (or mailing) petitionTelephone #:4.lf applicable, name and address of representative of owner, if representative is tiling application(Owner must complele Designation of Representative section.)Name of RepresentativeAii.o."'Telephone#:5. Property informationBlockLotBorough (Check one only)Manhattan (1)o Bronx (2) oBrooklyn (3) tr Queens (4) o Staten lsland (5) oNumberStreet3Name of owner or owners of property:-AAa.oo"' American LegalNet, Inc. www.FormsWorkFlow.com PART IIGROUNDS FOR PET IONA. Assessment requested on the affidavit for correction with lhe Tax CommissionTotal assessmentExempt amount, if anyTaxable assessmenlBCALCULATION OF EQUALIZED VALUE AND MAXII\4UM REDUCTION IN ASSESSI\4ENT1 t 1 Calculation of Equalized Value.ASSESSED VALUE + EQUALIZATION RATE = EOUALIZED VALUEt 1 lf the EOUALIZED VALUE exceeds $450,000, enter the ASSESSED VALUE herelvlultiply the ASSESSED VALUE by; x.25Enter the result hereThe result is the maximum total assessment request reduction allowableUNEOUAL ASSESSMENT: The total assessment is unequal because the property is assessed at a higherpercentage of full (market) value than (check one).[ ] (a) theaverageofall other property on the assessment roll, or[ ] (b) the average of residential property on the assessment roll.Full (market) value of property: $Based on one or more of the following, petitioner believes this property should be assessed al -7oof full (market) value:1 . [ ] The latest State equalization rate for the assessing unit in which the property is located (enter latestequalization rate%)2. [ ] The latest residential assessment ratio for the assessing unit in which the property is located (enterresidential assessment ratioa/o)3. [ ] A sample of market values of recent sales prices and assessments of comparable residentialproperties on which petitioner relies for objection (list parcels on a separate sheet and attach)4. [ ] Statements ofthe assessor or other local officialthat property has been placed on the roll ato/o.Petitioner believes the total assessment should be reduced to $This amount maynot be less than the total assessment amount indicated in Section A (1), or Section B (2), whicheveris grealer.DI ] EXCESSIVE ASSESSMEN-Complainant believes the total assessment should be reduced to a full value of $Attach list of parcels upon which complainant relies for objection, if applicable.This amount may not be less than the amount indicated in Section A ('l), or Section B (2).2. [ ] The taxable assessed value is excessive because ofthe denial ofall ora portion ofa partialexemption. Speciry exemption (e.9., aged, clergy, veterans, etc).Amountofexemptionclaimed:$-.Amountgranted,ifany:$-.ThisamoUntmay not be grealer than the amount indicated in A (2).lf application for exemption was filed, attach a copy of application to this petition.1.2c. tl1. I I Thetotal assessed value exceeds the full (market) value ofthe property.Total assessed value oI property: $ American LegalNet, Inc. www.FormsWorkFlow.com E1.INFORIVIATION TO SUPPORT THE FULL (MATKEI) VALUE CLAIMED[ ] Purchase price of property $Date of purchase -Relationship, if any, between seller and purchaser2. I I lf property has been recently offered for sale:When and for how longADDRESSBLOCK LOTHow offered:-Asking price: $3. [ ] ll property has been recently appraisedBy WhomPuroose of aooraisal:Appraised value: $4.t I lf buildings have been recently remodeled, constructed, or additional improvements made, stateYear remodeled, constructed, or additions madeDate commencedDate completed:Cost: $5. t I Amountforwhichyourpropertyisinsured: $Name of insurance company and policy number:6. t I lnformation concerning properties recently sold:DATEOF SALEPURCHASEPRICE American LegalNet, Inc. www.FormsWorkFlow.com PART IIIDESIGNATION OF REPRESENTATIVE TO FILE PETITION1, , as Petitioner hereby designateto act as my representative in any and all proceedings before the Small Claims Assessment Review of the SupremeCourt in County for purposes of reviewing the assessment of my real property as it appearson the year assessment roll of the City of New York.Signature of OwnerDateI certify that(d)The owner has previously filed a Application for correclion of Tentative Assessed Value.The property is improved by a Class 1 owner-occupied residential structure used exclusivelyfor residential purposes, andThe requested assessment is not lower than the assessment requested on the Application forCorrection flled wrth the Tax Commtssion.lf the equalized value of the property exceeds $450,000, the requested assessmentreduction does not exceed 25 percent of the assessed value.I will mail, by certified mail, return receipt requested, or, deliver in person, within ten days after the day offiling this petition with the County Clerk, one (1) copy of this petition to the New York City TaxCommission.I certify that all statements made on this application are true and correct to the best of my knowledge andbelief, and I understand that the making of any willful false statement of material fact herein will subjectme to the provisions of the Penal law relevant to the making and filing of false instruments.Signature of owner or representativeab(c)Check here if evening hearing is desiredPART IVELIGIBILITY AND CERTIFICATION American LegalNet, Inc. www.FormsWorkFlow.com