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Part One: General Information

Complaint on Real Property Assesment for which year?
Before the Board of Assessment Review for:
(City, Town, Village or County)
(General information and instructions for completing this form are contained in Form RP-524-Ins)
1. Name of Owner(s)
Daytime Phone Number
Evening Phone Number
2. Mailing Address of Owner(s)
Is a representative filing this application?
1. Yes
2. No
3. Name of Representative
Daytime Phone Number
Evening Phone Number
Mailing Address of Representative
4. Property Location
Street Address
Village (If Any)
City/Town
County
School District
5. Property Identification (See Tax Bill or Assessment Roll)
Tax Map Number or Section/Block/Lot
Type of Property
1. Residence
2. Commercial
1. Farm
2. Industrial
1. Vacant Land
2. Other
Description
6. Assessed Value Appearing on the Assessment Roll
Land Value
Total Value
7. Property Owner's Estimate of Current Full Market Value of Property
(See Part Two on Page 2)
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(If additional explanation or documentation is necessary, please attach)
Information to Support the Value of Property Claimed in Part One, Item 7
(Complete one or more)
1. Purchase Price of Property
a. Date of Purchase
a. Date of Purchase
b. Terms
1. Cash
1. Contract
1. Other
If other, please explain.
c. Relationship Between Seller & Purchaser
(Parent-child, in-laws, siblings, etc.)
Personal Property, If Any, Included in Purchase Price
(Furniture, livestock, etc.; attach list and sales)
Upload list and sales, if needed.
2. Property Has Been Recently Offered for Sale
(Attach copy of listing agreement, if any)
When and For How Long
How Offered
Asking Price
3. Property Has Been Recently Appraised
Upload Copy of Appraisal
When
When
By Whom
Purpose of Appraisal
Appraised Value
4. Description of Any Buildings or Improvements Located on the Property, Including Year of Construction and Present Condition
5. Buildings Have Been Recently Remodeled, Constructed or Additional Improvements Made
Complainant should submit construction cost details where available.
Cost
Date Started & Completed
Date Started & Completed Start Date
—
Date Started & Completed End Date
6. Property is income producing (e.g., leased or rented), commercial or industrial property, and the complainant is prepared to present detailed information about the property including rental income, operating expenses, sales volume and income statements.
1. Yes
2. No
7. Additional Supporting Document is Attached
1. Yes
2. No
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Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
I, (Complainant's Name), as complainant (or officer thereof), hereby designate (Representative's Name) to act as my representative in any and all proceedings before the board of assessment review of the city/town/village/county of (City/Town/Village/County) for purposes of reviewing the assessment of my real property as it appears on the (Year) tentative assessment roll of such assessing unit.
Read this agreement, and complete the corresponding fields below.
Complainant's Name
Representative's Name
City/Town/Village/County
Year
Signature of Owner (Or Officer Thereof)
Date
Date
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I certify that all statements made on this application are true and correct to be best of my knowledge and belief, and I understand that the making of any willful false statement of material fact herein will subject me to the provisions of the Penal Law relevant to the making and filing of false instruments.
Signature of Owner (Or Representative)
Date
Date
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The complainant (or complainant's representative) and assessor (or assessor designated by a majority of the board of assessors) whose signatures appear below stipulate that the following assessed value is to be applied to the above described property on the (Year) assessment roll. Provide Land Value and Total Value below.
1. Check box if stipulation approves exemption indicated in Part Three, Section B.2 or C.1.
Year
Land Value
Total Value
Complainant or Representative
Date
Date
Assessor
Date
Date
Anything beyond this point is for office use only. Please click submit.
Total Assessment
Transition Assessment (If Any)
Exempt Amount
Taxable Assessment
Class Designation and Allocation of Assessed Value (If Any)
Homestead
Non-Homestead

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