2019-03-27 Application for Property Tax Exemption (2) Application for Property Tax Exemption 3 �
wease read the back of this form before completing. If you are applying for exemption as a11 i1lStltUtl011 of pUt�ly �� o ',
public charity,please�ll out the "lnstitution of Purely Public Charity Application for P�operty Tax Exemption"form. � �
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This sec6on is to be comp/efed by a//applicants.P/ease provrde the fol%wing information for the organization = ;
that owns the property on which exemption is being claimed.
Name of organization Date property acquired by organizatiwn ��, ��,
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Name of representative or owner Title . Date yf applica p'on
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d- Mailing address of organization
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Y� City State Zip County
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� Is the above organization exempt from federal income tax under section 501(c)(3)? v 0 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 properly used exclusively for public purposes ❑ Other(specify) �;
❑ Pubiic burying ground
� Institution of purel y public charity(If yes,please file for exemption using the"Instftution of Purely Public Charity j�
Application for Property Tax Exemption"form J y;
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This section is to be completed by all applicants.Please fill out the following informa8on about the ; p O;
`o property on which exempfion is being daimed. o a;
10 Mailing,address � �
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- City State Zip County �-'
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oParcel ID number � � � �� v
Legal Description of the property ;� m
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This section is fo be completed by all applicants.Please answer the following questions about the ;; � i
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use of the property. ;o ,'�^
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What is the principal use ofthe above-described property. ,,, d
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� Addi6onal uses of the above-described property(please give percentage of use): ;�
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v Are these uses directly related to the mission of the organization� Yes ❑ No ;�
" Is any part of this property used for commercial purposes? ❑Yes �lo j�
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? If yes,please explain. ;�O
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Why is ownership of this property necessar�/? y ; �
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Is any part of this property used for residential purposes? ❑Yes No � ;
If yes,please fill out ne�section. d i
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This secSon is to be completed if any part of the property is used for residentia!purposes.Please � ;
fill out the following information for each person who occupies the above-described property.Lfst add'dional
tion on a se arate sheet and attach it to this applica6on. ,
occupant's informa p , ,
� � . Name of occupant Nature of service/employment � pull time O� ❑ Part time ;
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t Is occupant required to reside on this properry as a condition of employment? ❑Yes ❑ No
o 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,pfease give details. d ;
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Why is ownership of this residence necessar)/?
Signature of owner or authorized representative.By signing below, I certify that the above information is frue i '
and correct to the best of my knowledge,and I am the owner of the properfy or aufhorized represenfative of the
organizatron that owns the property for which exemp6on is being daimed.
� Making false sWtements on this application is against the law.
�, Minnesota Statute 609.41 states that anyone giving false information 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.
� - Applicant' signature _ Daytime phone � � �
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