2019-03-27 Application for Property Tax Exemption (2) Appiication for Property Tax Exemption 3
Piease read tne back of this form before complefing. If you are applying for exemptlon aS al1 II1StItUtI0110f pUC@ly �� o��,
public charity,please fill ouf the "Institution of Purely Public Charity Application fo�Property Tax Exemption"form. � �
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This section is to be completed 6y a//applicants.P/ease provide the following information for the organization - ; � ;
that owns the property on which exemption is being claimed.
Name ot oryanization Date property acquired by organizalion �
C. �- � d� 1 b e,�-u d'1 l� � t�
Name of representative or owner Title Date of applicatio
�, 1 i nc� L�n r�r� ���n�ee D,'�e.�-��, 3 � l�
a: Mailing address of organization
a 595 `� m�� Y� rv £
�: City State Zip County
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aIs the above organization exempt from federal income tax under section 501(c)(3)? ❑Yes ❑ No
o' The 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 liouse of worship ❑ Public school house �
�Public property 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 �;
Application for Property Tax Exemption"form.) �
�
This sectian is to be completed by all applicants.Please fill out the following information about the ; � �;
`o propedy on which exemption is being claimed. �
� D;
E�� �. Mailing address �,v �
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City State Zip County a;
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° legal Description of the property Parcel ID number � - � ;� N
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This section is to be completed by all applicants.P/ease answer the following questions about the � N '
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use of the property. ;g �
What is the principal use of the above-described propert�/? j" m
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� Additional uses of the a ove-de cribed property(please give percentage of use): ;p
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LAre these uses directly related to the mission of the organization? [�Yes ❑ No ;g
" Is any part of this property used for commercial purposes? ❑Yes �No ;�
o ;�n
y If yes,please explain. ;�
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Why is ownership of this properLy necessary? n '
y �
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N
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Is any part of this properiy used for residential purposes? ❑Yes �,No � :
If yes,please filI out ne�section. V ;
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This section is to be completed if any part of fhe proper/y is used for residential purposes.Please ; ,
fill out the following information for each person who occupies the above-described property. List additional
occupanYs information on a separate sheet and attach it to this applrcatron.
� � Name of occupant Nature of service/employment r Part time �
a
❑
Full time o ❑ ,
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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?
N
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w Does occupant pay rent,either in cash or as a part of salar�/? ❑Yes ❑ No ;
;� If yes,please give details. � ;
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a
W hy is ownership of this residence necessary?
Signature of owner or authorized representative.By signing below, I certify that fhe above information is true ; �
and correct to the best of my knowledge, and I am the owner of the property or authorized representafive of the
organization that owns the proper(y for which exemption is being claimed.
t Making false statements on this application is against the IaW.
m 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.
Applic s signature Daytime phone
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Revised 01l04