2019-03-27 Application for Property Tax Exemption Application for Property Tax Exemption � ;
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P�ease read the back of this form before complefing. If you are applying fof eX@mpf1011 aS an II1StItUtI0110f pUC@I]I �� o �,
public charity,please fill out fhe '7nstitution of Pu�ely Public Chari(y Application for Property Tax Exemption"form. � �
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This sec6on is to be completed by a//applicants.P/ease provrde the following iniormation fo�the oiganization ; � ;
that owns the property on which exemption is being claimed.
Name of organization Date property acquired by organizatlon ��,
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Name of representative or owner Title Date of oolica ion
� 'I rc� L� n na ' ��n��ce D;��e.c.�-�-t_ 3��7� ��, .
d � Mailing address of organization
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�: City State Zip County
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� Is the above organization exempt from federal income tax under section 501(c)(3)? ❑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 properly or house of worship ❑ Public school house �
�' Public properly used exclusively for public purposes ❑ Other(specify) �i
❑ Public burying ground � ;
� Institution of purely public charity(if yes,please file for exemption using the"Institution of Purely Public Charity j;
Application for Property Tax F�cemption"form.) �;;
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This section is to be completed by all applicants.Please fill ouf the following info�mation abouf the : � 0;
o` properfy on which exempfion is being daimed. �
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€ Mailing address � � �,o �
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C� State Zip County o-'
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°� Legal Description of the property Parcel ID number - ;� N
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This secfion is to be completed by all applicants.Please answer the following questions about the ' ;
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use of the property. ;o �
What is the principal use of the above-described propert�!� ;� m
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� Additio I suan�es of the above-described property(please give percentage of use): ;a
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'' Are these uses directly related to the mission of the organization? ,�Yes ❑ No :�
� Is any part of this property used for commercial purposes? ❑Yes '�;No ;�
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If yes,please explain.
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Why is ownership of this property necessar�/? n i
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Is any paR of this property used for residenfial purposes? ❑Yes No y ;
If yes,please fill out ne�A section. � �
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This section is to be completed if any part of the property is used for residential purposes.Please ; ;
fill out the following information for each person who occupies the above-described property.List add'dional
occupanPs information on a separate sheet and atfach it to this application. ;
aName of occupant Nature of service/employment � FUII tifT12 Of ❑ Part time ;
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s Is occupant required to reside on this properry as a condition of employment? ❑Yes ❑ No
a If yes,why is this required?
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� Does occupant pay rent,either in cash or as a part of salar�/? ❑Yes ❑ No ;
,� If yes,please give details. m �
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Why is ownership of this residence necessap/?
Signature of owner oi authorized representative.By signing below, I certi(y that the above information is true � '
and conect to fhe best ofmy knowledge, and 1 am the owner of the proper(y or authorized representafive of fhe
organizafion that owns the property for which exemp6on is being claimed.
,� Making false statements on this application is against tl7e law.
m Minnesota Statute 609.41 states that anyone giving false information in order to avoid or reduce
y their tax obligations is subject to a fine of up to$3,000 and/or up to one year in prison.
Applican' signature � Daytime phone � �
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Revisetl 01/04