2019-03-27 Application for Property Tax Exemption Application for Property Tax Exemption � ;
Please read the back of this form before completing. If you are applylflg fOf 8X2R1pf1011 aS all IIIStItUt1011 Of pUC@Iy ��, o �,
pUbliC charity,please fill out the "Institution of Purely Public Chari(y Application for Property Tax Exemption"form. � ;
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This section is to be comp/efed by all applicanis.P/ease provide the fo!lowing information for the organization : � ;
that owns the proper(y on which exemption is being claimed. �
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Name of organization n 1 _ Date property acquired by organization ���
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Name of represen[ative or owner Title Date of pplicaf n
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a� Mailing address of organization
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Y.. City State Zip County
o l3 1 h�.� ��� yn ,� Ss 3 a � c,��;�
v 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,universily or seminary of leaming ❑ Public hospital
�hurch,church property or house of worship ❑ Public school house �
Public properly 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 Charity ?;
Application for Properly Tax Exemption"form.) �;;
This section is to be completed by all applicants Please fill out the following information about the ; � �;
o properly on which exemption is being claimed. �
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. Mailing address � '�a j
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�, City State Zip County �� a�
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°� Legal Description of the property Parcel ID number � � � ;� �
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This sectiort is ta be completeal by all applicants.Please answer the following questions about the ;
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use of the property. ;o �
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What is the principal use of the above-described properl�R ;� m
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� A ditional uses of the above-described property(piease give percentage of use): i P i
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a Are these uses directly related to the mission of the organization? �,Yes ❑ No ;�
w Is any part of this property used for commercial purposes? ❑Yes 0'No ;�
NIf yes,please explain. ,,�
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Why is ownership of this property necessar�/? n '
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y
N
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Is any part of this property used for residential purposes? ❑Yes o " '
If yes,please fill out ne�section. ' �
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This sec6on is to be completed if any part of fhe properiy is used for residentia(purposes.Please ; ;
fill ouf the following information for each person who occupies the above-described property.Lfsf additional
occu anYs information on a separate sheet and attach if to this applicaSon_
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�� Name of occupant Nature of service/employment � FUII tlfne 01' ❑ Part time �
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s Is occupant required to reside on this property 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,please give details. � !
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Why is ownership of this residence necessaq/?
Signature of ownei oi authorized representative.By signing 6e/ow,I cerfi(y that the above information is true � �
and conect to fhe best of my knowledge,and I am the owner of the property or authorized representative of the
organization that owns the proper(y for whrch exempfion is being daimed.
zMaking false statements on this application is against the law.
�, 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'S 5ignatUre Daytime phone
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Revised 01/04