TP-584-SNY (1/14)
                                                                                                                  Recording office time stamp
                                New York State Department of Taxation and Finance
                             Real Estate Transfer Tax Return
                                for START-UP NY Leases

See instructions on back before completing this form. Print or type.
Information relating to conveyance
Grantor/Transferor   Name (if individual, last, first, middle initial)     ( mark an   ifXmore than one grantor)                  Social security number
Individual
Corporation          Mailing address                                                                                              Social security number
Partnership
Estate/Trust         City                                                                           State         ZIP code        Federal EIN
Single member LLC
Other                   Single member’s name if grantor is a single          member LLC(see instructions)                         Single member EIN or SSN

Grantee/Transferee   Name (if individual, last, first, middle initial) (     mark an  Xif more than one grantee)                  Social security number
Individual
Corporation          Mailing address                                                                                              Social security number
Partnership
Estate/Trust         City                                                                           State         ZIP code        Federal EIN
Single member LLC
Other                   Single member’s name if grantee is a single          member LLC (see instructions)                        Single member EIN or SSN

Location and description of property conveyed
    Tax map designation –
    Section, block & lot                                      Street address                                      City, town, or village          County
    (include dots and dashes)

Condition of conveyance (mark an  Xin the appropriate box) 
Leasehold grant - enter maximum term of lease, including all option periods (see instructions): 
Leasehold assignment

Date of conveyance
                    month       day       year

The undersigned certify that the conveyance of real property is exempt from the real estate transfer tax because the conveyance is a lease 
of real property located in a tax-free NY area to an approved business participating in the START-UP NY program. The undersigned further 
certify that the information contained in this form, including any certifications or attachments, is to the best of his/her knowledge, true and 
complete, and authorize the person(s) submitting such form on their behalf to receive a copy for purposes of recording the lease or other 
instrument effecting the conveyance.
  Grantor signature                   Title                                                 Grantee signature                     Title

  Grantor signature                   Title                                                 Grantee signature                     Title

 For recording officer’s use              Date received                                                         Transaction number

TP-584-SNY (1/14) (back)

                                                            Instructions

Purpose of Form TP-584-SNY                                             Information relating to conveyance
Use Form TP-584-SNY to claim exemption from the real estate            Name and address box
transfer tax related to leases of real property located in tax-free NY 
areas to an approved business participating in the START-UP NY         Print or type the names, addresses, and social security or employer 
program.                                                               identification numbers of the grantor and grantee. If the grantor 
                                                                       or grantee is a single member LLC, enter the names and 
Note: You must file Form TP-584 for all other conveyances of real      identification numbers (SSN and/or EIN) for both the LLC and 
property located in New York.                                          the single member. If additional space is needed, please attach a 
                                                                       schedule to Form TP-584-SNY setting forth the names, addresses, 
When and where to file                                                 and social security or employer identification numbers of all the 
File Form TP-584-SNY with the recording officer of the county          grantors and grantees.
where the real property being conveyed is located, no later 
than the fifteenth day after the delivery of the instrument            Location and description of property conveyed 
effecting the conveyance. However, if the instrument effecting         Give the location and description of the interest in real property 
the conveyance will not be recorded, file Form TP-584-SNY no           being leased including the tax map designation and address. Also 
later than the fifteenth day after the delivery of the instrument      include the name of the city or village, town, and county where the 
effecting the conveyance, directly with:                               property being leased is located.
     NYS TAX DEPARTMENT 
     RETT RETURN PROCESSING                                            Condition of conveyance
     PO BOX 5045                                                       Indicate by marking an  Xin the appropriate box whether the 
     ALBANY NY 12205-0045                                              property conveyed is a leasehold grant or leasehold assignment. If 
                                                                       the conveyance is a leasehold grant, indicate the maximum term of 
Private delivery services – If you choose, you may use a private       the lease (by number of years), including all options to renew.
delivery service, instead of the U.S. Postal Service, to mail in your 
form and tax payment. However, if, at a later date, you need to        Date of conveyance
establish the date you filed or paid your tax, you cannot use the      The exemption applies to leases conveyed on or after January 1, 
date recorded by a private delivery service unless you used a          2014.
delivery service that has been designated by the U.S. Secretary 
of the Treasury or the Commissioner of Taxation and Finance.           For leasehold grants, enter the date the lease commences as 
(Currently designated delivery services are listed in Publication 55,  stated in the leasehold agreement.
Designated Private Delivery Services. See Need help? for               For leasehold assignments, enter the effective date of the 
information on obtaining forms and publications.) If you have used     assignment as stated in the assignment agreement.
a designated private delivery service and need to establish the 
date you filed your form, contact that private delivery service for 
instructions on how to obtain written proof of the date your form      Signatures
was given to the delivery service for delivery. If you use any private Both the grantor(s) and the grantee(s) must sign Form TP-584-SNY.  
delivery service, whether it is a designated service or not, send      If there is not adequate space for all persons to sign, a separate 
the forms covered by these instructions to: NYS Tax Department,        signature sheet may be used and attached to Form TP-584-SNY.
Misc Tax/RETT Unit, W A Harriman Campus, Albany NY 12227. 

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