PROPERTY OWNER'S INFORMATION
 
 
 
BBL(s) and ident(s) of the utility parcel(s):*
 
 
 
 
 
Property owner's tax identification number (complete one):
 
 
 
Individual (Social Security Number)
 
 
 

OR
 
 
 
Corporation (Employer Identification Number)
 
 
 
 
 
 
Property owner's name (complete one):
 
 
 
Owner's First Name
 
 
Owner's Last Name
 
 
 

OR
 
 
 
Owner's Corporation Name
 
 
 
 
 
 
 
Property owner's business address:
 
 
 
Owner's Street Address
 
 
 
 
Owner's Floor/Suite/Room
 
 
 
 
Owner's City
 
 
Owner's State
 
 
Owner's Zip code
 
 
 
 
 
Contact person and email address for the owner:
 
 
 
Contact's First Name
 
 
Contact's Last Name
 
 
Contact's Title
 
 
Email
 
 
Phone
 
 
 
 
 
 
 
 
PROPERTY TAX BILLING INFORMATION:
 
 
 
The property tax bill for this property should be sent to (choose one):*
 
Property owner’s business address
Owner’s agent
 
 
 
 
 
If you selected "Owner's Agent" above, please provide the following information:
 
 
 
Agent's Contact Name or Department
 
 
 
 
Agent's Corporation Name
 
 
 
 
Agent's Street Address
 
 
 
 
Agent's Floor/Suite/Room
 
 
 
 
Agent's City
 
 
Agent's State
 
 
Agent's Zip code
 
 
Agent's Email
 
 
Agent's Phone
 
 
 
 
 
 
 
 
ELECTRONIC SIGNATURE
 
 
 
Please enter your full name.*
 
 
Date*