2019-03-27 Application for Property Tax Exemption Application for Property Tax Exemption � 3�
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Please read fhe 6ack of this form before completing. If you al'e eppiyltlg fOf @X2mpt1011 aS 811 II1StItUt1011 Of pUC@IJI � o �
public charity,please fill ouf the"Instihrfion of Purely Public Charity Application for Propedy Tax Exemption"form. � �
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This section is to be completeal by a//applicants.P/ease provide the following information for the organizaSon � :
that owns the property on which exemption is being claimed.
Name of or9anization Date property acquired by organizaiion ��,
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Name of representative or owner Title Date of applicati n
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a.�� Mailing address of organization
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Y City Siate Zip Counry
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a Is the above organi�tion exempt from federal income tax under section 501(c)(3)? v ❑Yes ❑ No
oThe above organization is seeking exemption from property tax under the following category(please check one):
❑ Academy,college,university or seminary of leaming ❑ Public hospital ;
❑ Church,church property or house of worship ❑ Public school house
� Public property used exclusively for public purposes ❑ Other(specify) �;
Public burying ground �;
� Institution of purely public charity(If yes,please file for exemption using the"Institution of Purely Public Cha ri i y ?;
Application for Properly Tax Exemption"form.) v;�
This section is to'be completed by all applicants.Please fill out the following information about fhe ; � �;
o propeKy on which exempfion is being daimed. p y;
10 � Mailing address ? �O '
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� � State Zip County a'
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°� Legal Description of the pmperty Parcel ID number - �
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This secSon is to be completed by all app/icants.Please answer the following questions about the ;; � ;
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use of fhe property. ;a ,�
What is the principal use of the above-described propert�/? �� �
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� Additional uses of the above-described property(please give percentage of use): ,a
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a Are these uses directly related to the mission of the organization? �Yes ❑ No ;�
� Is any part of this properly used for commerciat purposes? ❑Yes �No "�
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NIf yes,please explain. i�
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Why is ownership of this property necessaq/? y �
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Is any part of this property used for residential purposes? ❑Yes �No � j
ff yes,please fill out next section. d �
This section is to be completed if any part of fhe property is used for residential purposes.Please ; � ;
fill out the following informalion for each person who occupies the above-descnbed property.Ust addiGonal
occupanPs informa6on on a separate sheet and attach it fo this application. ;
'� Name of occupant Nature of service/employment � Full time ol' ❑ Part time ;
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s Is occupant required to reside on this properly as a condition of employment? ❑Yes ❑ No
o If yes,why is this required?
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16 Does occupant pay rent,either in cash or as a part of salar�? ❑Yes ❑ No ;
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;� If yes,please give details. � ;
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Why is ownership of this residence necessary?
Signature of owner or authorized representative.By signing below, 1 certi(y that the above information is true � '
and correct to the best of my knowledge,and!am the owner of the property or authorized representative of the
organization that owns the property for whrch exemption is being claimed.
rMaking Yalse statements on this application is against the law.
rn Minnesota Statute 609.41 states that anyone giving false infortnaBon in order to avoid or reduce
�n their tax obligations is subject to a fine of up to$3,000 and/or up to one year in prison.
ApplicanYs gnature Daytime phone, � ; �
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Revisetl Otl04
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