2019-03-27 Application for Property Tax Exemption Application for Property Tax Exemption 3;
Please read the back of this form before completing. If you are applying for eX2mpf1011 aS all IOStItUt1011 Of pUCely ' ° '
publicthat o��hea So,le� on wh c�xeY I f PP�I cantsll P/ease pro�de/the'folf owi�g info�imation foe fhe oigan�i aY ihbn I' � !' I
p p rt y m p fi o n i s b e m g c l a i m e d.
Name of organization Date property acquired by otganiZatioll ��
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Name of representative or owner Title Date of pplication
� "1 7 nc� L� n r�e ���c�� D�'�e.c,i-�, 3 ot `7�� �
a-� Mailing address of organization -
° 5 9 5 R m�,�n � r� £
a
w City
SWte Zip Coun
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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 fol�owing category(please check one):
❑ Academy,college,university or seminary of leaming ❑ Public hospital
❑ Church,church property or house of worship ❑ Public school house �
�Public praperty used exclusively for public purposes ❑ Other(specify) X;
Public burying ground � ;
� Institution of purely public charity(If yes,please file for exemption using the"Institution of Purely Public Charity ��
Application for Property Tax Exemption"form.)
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This section is to be completed by all applicants.P/ease fill out the following information about the ' O O;
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o property on which exemption is being claimed.
€ . Mailin address � D'
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= 5 �.�� ti�� Q � ;
C��Y State Zip County Q:
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a Legal Description of the property ParcelI ID number � � (°� p�
4:?d �a'�'� 1i,:3"�c� Va �Q 1 ^ � � 7 �^-(�Q�.''�c��P �m
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This secfion is to be comp/eted by all applicants.Please answer fhe iollowing questions about the �� `� �
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use of the property. ;� �
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What is the principai use of the above-described property� ;� v
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="✓.��„n S��i ,�t� Ltx.r.'�" �f�-vw� �a
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� RUditional uses of the above-described property(please give percentage of use): ;�
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LAre these uses direcUy re�ated to the mission of the organization7 B Yes ❑ No ;�
p Is any part of this property used for commercial purposes? ❑Yes '�'�lo ;�
= If yes,please explain. i�
Why is ownership of this property necessary? �� a ;
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. y
Is any part of this properly used for residential purposes? ❑Yes �lo y '
If yes,please fill out ne�section. �; ;
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This section is to be complefed if any part of fhe proper(y is used forresidenGal purposes.Please ; � �
fill out the following information for each person who occupies the above-described proper(y.L fsf addifional
occupanYs infortnation on a separate sheet and attach it to this application.
� . Name of occupant Nature of service/employment
o ❑ Full time or ❑ Part time �
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t Is occupant required to reside on this property as a condition of employment7 ❑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
9 If yes,please give details. o ;
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Why is ownership of this residence necessar�?
Signature of owner orauthorized representative.By signing be%w,I certi(y that the above info�matron is true ; i
and correct to the best of my knowledge,and I am the owner of the property or aufhorized representative of the
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oryanization that owns the property fo�which exemption is being daimed.
' Making false statements on this applieation is against the IaW.
�, 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 Da time phone
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ReNsetl 01/04 �