Of?ce of Development Department Of DIVISION OF HOUSING INCENTIVES Housmg Preservatlon 100 GOLD STREET, NEW YORK, NY. 10038 Development (212) FINAL APPLICATION FOR CERTIFICATION OF ELIGIBILITY FOR 421~a PARTIAL TAX EXEMPTION Property address: Docket Date rec'd by HPD: Block: Lot: To the Commissioner: The undersigned af?rms that: (Place an where applicable) Cl All information previously submitted in the Preliminary Application for a Certi?cation of Eligibility for partial tax exemption remains true and accurate. El Documentation is attached advising you of all physical changes made in this project since the submission of the Preliminary Application; and the need, if any, to revise initial rents or selling prices. LII Documentation is attached advising you of increased development and/or maintenance and operating costs and the need for revised initial rents or selling prices. Cl Each year the owner shall make available to Tax Incentives Unit a schedule of rents for each unit in the building. An annual rent schedule must be mailed to HPD. Cl All units have been registered with the New York Stale Division of Housing and Community Renewal. Date: Cl All units in the above building/s will be registered with the NYS Division of Housing and Community Renewal as they become occupied. Cl If the project is owned and operated as a co-op or condominium and if the co-op or condo plan has not been declared effective 15 months after the issuance of a Final Certi?cate of Eligibility, the owner will register the rental units with the NYS Division of Housing Community Renewal no later than 15 days after such 15 month period. The approximate date of completion of this project is: Applicant understands that pursuant to Sec. 6-05 (2) of the 42l-a Rules that: A. The application for a Final Certi?cate of Eligibility must be ?led as follows: I. For a multiple dwelling owned as a rental and containing more than six units, the application must be ?led prior to occupancy of the building, but no earlier than the date of application for a preliminary certi?cate of eligibility. For a multiple dwelling to be owned as a condominium or co-op, the application must be ?led prior to the ?rst taxable status date following the completion of construction. Ix.) B. The application process for a Final Certi?cate of Eligibility must be completed within 90 days following the issuance of a permanent certi?cate of occupancy or a temporary certi?cate of occupancy covering all residential space. In the event that all the required documents are not timely ?led, bene?ts of the Act may be revoked pursuant to Sec. 6-07 (5) of the 421-a Rules. Applicant understands and agrees that, if tax exemption is granted as a result of this application and there is failure to complete said structure within the time limit set forth in the 421-a Statute and Rules, or if any other breach of the Rules is committed without curing said breach within 90 days after notice of same is given, the Commissioner shall revoke the Certi?cate of Eligibility for said premises. In the event of Revocation for failure to timely complete, the owner shall pay the City, with interest, the amount of exempted taxes. Such unpaid taxes and the interest thereon shall become a lien against said property. Af?davit is herewith submitted for the issuance of a ?nal certi?cation of eligibility for partial tax exemption for the structure herein mentioned. STATE OF NEW YORK CITY OF NEW YORK COUNTY OF being duly sworn, deposes and says, that, he/she is the applicant or of?cer of applicant Corp. or General Partner of making application for a Certi?cation of Eligibility for Partial Tax Exemption; he/she has read and agrees to abide by the Regulations for 421-a partial tax exemption, and he/she understands that the City of New York will rely on the statements contained herein in acting upon this application. Sworn to before me this day of 20? Signature Notary Public Date (November 201m Office of Development DIVISION OF HOUSING INCENTIVES Department Of 100 GOLD STREET, NEW YORK, NY. 10038 Housing Preservation (212) 863-8540 Development COMPLETION OF CONSTRUCTION AFFIDAVIT The date of ?completion of construction? of the project is a very important date for the implementation of 421-a bene?ts. It con?rms that the project completed construction and is eligible for the 10, 15, 20, or 25 years of post-construction partial tax exemption bene?ts. This af?davit must be completed by the project architect or engineer and submitted to HPD with the application for a ?nal certificate of eligibility. A separate af?davit must be ?led for each building included in the project. Docket 3 Building Address: Block: Lot: i Borough: Manhattan Bronx Brooklyn Staten Certi?cate of Date Issued Date Expired Indicate Temporary Occupancy CO or Permanent CO l, the undersigned architect or engineer for the project, hereby certify that this is a complete and accurate list of all temporary and, if any, permanent certi?cates of occupancy issued for the building from the commencement of construction to date. I make this af?davit in support of the application submitted to the Department of Housing Preservation and Development for a ?nal certi?cate of eligibility for 421~a Partial Tax Exemption Bene?ts. Based on the attached documentation, the construction was completed on the earlier of the date of issuance of the ?rst temporary certi?cate of occupancy issued for all residential areas of the building or the permanent certificate of occupancy for the entire building. Notary or Seal Signature of Architect or Engineer Print Name Address City, State, Zip Telephone Number ONLY ORIGINAL AF FIDAVITS WILL BE ACCEPTED BY HPD THEY MAY NOT BE ALTERED IN ANY WAY (November 2010) Of?ce of Development DIVISION OF HOUSING INCENTIVES Department of 100 GOLD STREET, NEW YORK, NY. 10038 Housmg Preservation (212) 863-8540 Development AFFIDAVIT OF ENERGY STAR COMPLIANCE STATE OF NEW YORK DOCKET ss: COUNTY OF being duly sworn, under penalty of perjury, deposes and says: I am the of [title] [name Of entity] owner of premises located in the County of City and State of New York, identi?ed as block lot(s) on the tax map of the City of New York, making this application for a Preliminary Certi?cate of Eligibility for a ?421~a Partial Tax Exemption. I hereby certify, as required pursuant to ?11-245.8 of the Administrative Code of the City of New York and of Chapter 6, Title 28 of the Rules of the City of New York, that whenever any household appliance in any dwelling unit, or any household appliance that provides heat or hot water for any dwelling unit in the multiple dwelling, is installed or replaced with a new household appliance on or after December 19, 2006, such new appliance shall be certi?ed as Energy Star, or that either (A) an appropriately-sized Energy Star certi?ed household appliance is not manufactured, such that movement of walls or ?xtures would be necessary to create suf?cient space for such appliance, and/or (B) an Energy Star certi?ed boiler or furnace of suf?cient capacity is not manufactured.1 I make these statements to induce the Department of Housing Preservation and Development of the City of New York to grant a partial tax exemption and know the City of New York will rely on the veracity of such statements in granting tax exemption. The attached application is intended to be a written instrument as de?ned in Article 175 of the Penal Law and I understand that any false statement is punishable as a Class felony that provides a term of imprisonment not to exceed four years. Sworn to me this day of 20 Af?ant Signature Name Notary Public Title Name of Entity (if applicable) 1 For purposes of this paragraph, (A) ?household appliance? shall mean any refrigerator, room air conditioner, dishwasher or clothes washer, within a dwelling unit in the multiple dwelling that is provided by the owner, and any boiler or furnace that provides heat or hot water for any dwelling unit in the multiple dwelling, and (B) ?Energy Star? shall mean a designation from the United States Environmental Protection Agency or Department of Energy indicating that a product meets the energy ef?ciency standards set forth by the agency for compliance with the Energy Star program. (November 2010) Of?ce of Development DIVISION OF HOUSING INCENTIVES Department of 100 GOLD STREET, NEW YORK, NY. 10038 Housmg Preservation (212) 863-3540 Development INTERIM AFFIDAVIT OF RENT REGISTRATION FOR NEWLY CREATED DWELLING UNITS IN BUILDINGS EXPECTED TO BE OPERATED AS RENTALS STATE OF NEW YORK DOCKET SS: COUNTY OF being duly sworn, under penalty of perjury, deposes and says: I am the of [title] [name of entity] owner of premises located in the County of City and State of New York, identi?ed as block lot(s) on the tax map of the City of New York and make this af?davit in support of the Final application for 421-a partial tax exemption bene?ts pursuant to Section 421-a of the Real Property Tax Law of the State of New York. I hereby af?rm that for each of the dwelling units in the premises, a ?ling for rent registration with the New York State Division of Housing and Community Renewal, as required by law, will be made no later than thirty days after initial occupancy or at the earliest date thereafter permitted by DHCR. I make these statements to induce the Department of Housing Preservation and Development of the City of New York to grant a partial tax exemption and know the City of New York will rely on the veracity of such statements in granting tax exemption. Sworn to me this day of 20 Af?ant Signature Name Notary Public Title Name of Entity (if applicable) (November 2010) CERTIFIED PUBLIC ACCOUNTANT LETTERHEAD CPA HPD Docket Property Address: Borough: Block: Lot(s): To: Of?ce of Development Tax Incentives - 421(a) Programs I am an independent certi?ed public accountant, registered as such by and in good standing with the New York State Education Department. My number is I have examined the books and records of the builder/developer of the above building(s) and have determined from my examinations that the actual development costs were 33 My examination was made in accordance with generally accepted auditing standards, and accordingly included such tests of the accounting records and such other auditing procedures as I considered necessary under the circumstances. In my opinion, the above-mentioned costs were expended for the construction of the premises described above. As an independent certi?ed public accountant, I declare that I am in no way connected with the applicant, ?nancially or otherwise. I have read this certi?cation and I hereby af?rm under the penalties provided by law that the contents thereof are true of my own knowledge. Print Name Signature Date NOTARY: Sworn to before me this of 20 In the event the ?nal costs are different than the estimated costs, please add ?the reason why the actual development costs shown here is different from the original costs set forth previously by the developer? is because the original costs 35 were estimated prior to the completion of construction and the amounts set forth above are the actual costs. CERTIFIED PUBLIC ACCOUNTANT LETTERHEAD CPA SAMPLE HPD Docket Property Address: Borough: Block: Lot(s): To: Of?ce of Development Tax Incentives - 421(a) Programs I am a certi?ed public accountant, registered as such by and in good standing with the New York State Education Department. My license number is have audited the books and records of pertaining to the development of (Project) and have determined that the actual development costs were I conducted my audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that I plan and perform the audit to obtain reasonable assurance about whether the ?3 total actual development costs incurred are free of material misstatement. An audit includes examining, on test basis, evidence supporting the ?3 total actual development costs incurred and performing such other procedures as I considered necessary in the circumstances. An audit also includes assessing the accounting principles used by management. I believe that my audit provides a reasonable basis for my opinion. In my opinion, the total actual development costs referred to above present fairly, in all material respects, the total actual development costs of the Project in conformity with accounting principles prescribed by the New York City Department of Housing Preservation and Development. I have no ?nancial interest in the Project other than in the practice of my profession. I have read this certi?cation and hereby af?rm, under the penalties provided by law, that the contents thereof are true of my knowledge. Print Name Signature Date NOTARY: Sworn to before me this __day of 20 In the event the ?nal costs are different than the estimated costs, please add ?the reason why the actual development costs shown here is different from the original costs set forth previously by the developer? is because the original costs 3 were estimated prior to the completion of construction and the amounts set forth above are the actual costs. Certified Public Accountant Letterhead Re: HPD Docket Property Address PL Borough A Block and Lot(s) To: Office of Development Tax Incentives RPTL 421-a Program We are an independent certified public accounting firm licensed to practice in the State of New York. We have audited the development costs of the builder/developer of the above building, as of [date of audit]. The development costs amounting to is the responsibility of management. Our responsibility is to express an opinion on this amount based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the development costs are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the development costs. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall presentation. We believe that our audit provides a reasonable basis for our opinion. The development costs incurred were determined for the purpose of complying with the City of New York Department of Housing Preservation and Development?s requirements, in accordance with the RPTL 421*a tax benefit program. It is not intended to be a determination of costs in conformity with accounting principles generally accepted in the United States of America. in our opinion, the development costs referred to above presents fairly, in all material respects, the development costs of as of [date of audit], in accordance with the RPTL 421~a tax benefit program prescribed by the City of New York Department of Housing and Preservation. As an independent certified public accounting firm, we declare that we are in no way connected with the applicant, financially or otherwise. This report is intended solely for the information and use of the partners of and the City of New York Department of Housing Preservation and Development and should not be used by anyone other than these specified parties. Signature of Firm Name of Partner Signing on Behalf of Firm NOTARY: Sworn to before me this day of 20__ In the event the final costs are different than the estimated costs, please add ?the reason why the actual development costs shown here is different from the original costs set forth previously by the developer? is because the original costs 5 were estimated prior to the completion of construction and the amounts set forth above are the actual costs. 421-a Addendum to CPA certification of Actual TotaI Development Cost (itemized) Address of Project: Blockllot 1. LAND ACQUISITION (ATTACH DEED) a) Purchase Price (attach contract of sale or closing statement) b) Appraisal (if required?see 421?a Rules 6-05 (1) (A) c) Ground Lease (for month) d) Relocation and other expenses 9) Air Rights f) Other (please specify) 2. CONSTRUCTION COSTS a) Demolition and Site Clearance Costs b) Abnormal Foundations Conditions c) Hard Construction Costs (attach itemization to erect bildg/s) d) Lawn/Plantings e) Roads/Walkways f) Site Work 9) Other (please specify) 3. PROFIT PROFESSIONAL AND OTHER FEES a) Architect's Fee b) Engineer?s Inspection fee c) Laboratory Fees d) Soil Investigation 9) Preliminary Surveys f) Project supervision fee 9) Legal fees h) Environmental Surveys/Reports l) Controlled Inspection Fee j) Accounting fees k) Consultant fees I) Appraisal fees m) 421?a Partial Tax Exemption Filing Fee n) Cost of 421-3 Negotiable Certi?cates (Purchase price only, include copy of contract of sale) 5. MARKETING EXPENSES a) Commissions/Sales Expenses b) Advertising c) Other (please specify) 6. FINANCING AND OTHER CHARGES a) Construction interests Loan Fee b) Rent-up interest c) Construction Real Estate Taxes d) Rent~up Real Estate Taxes e) Title and Recording Expenses f) Construction Insurance (?re/liability) g) Water/Sewer h) Other (please specify) 7. TOTAL PROJECT COST