Renewal Application for Real Property Tax Exemption for Nonprofit Organizations
Part 1: Organization Purpose
Name of Organization
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location of Property
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Employer ID # (Do not include special characters in this field)
*
Tax Map Number of Section/Block/Lot Property Identification (Do not include special characters in this field)
*
Have any of the following changes occurred since the last application for this property tax exemption was filed? If any of the listed changes have occurred, provide a detailed explanation of each change in the space provided below, mark the appropriate boxes below and complete and sign the statement. If none of the changes have occurred, mark the box next to "Statement of no change" below and complete and sign the statement.
A change has occurred in the purpose(s) of the organization
A change has occurred in the organization as a result of action taken by one or more regulatory agencies (such as issuance, restriction, or withdrawal of an operating certificate, permit or similar authorization).
A change has occurred in the organization's status with regard to exemption from federal income taxes (such as exempt status has been recognized, denied, or revoked by the Internal Revenue Service (IRS), or the Internal Revenue Code classification of exemption has been changed).
Statement of Change - I hereby certify that all of teh changes, as listed above, that have occured since application for exemption was last filed have been noted and the explanation of such changed are true and correct to the best of my knowledge and belief.
Statement of no change - I herby certify that none of the changes listed above have occurred since the last application for an exemption was filed to the best of my knowledge and belief
Explanation of Changes
Renewable Application for Real Property Tax Exemption for Nonprofit Organizations
Part 2: Property Use
Have any of the following changes occurred since the last application for this property tax exemption was filed? If any of the listed changes have occurred, provide a detailed explanation of each change in the space provided below, mark the appropriate boxes below and complete and sign the statement. If none of the changes have occurred, mark the box next to "Statement of no change" below and complete and sign the statement.
A change has occurred in the ownership of all or part of the property
A change has occurred in the use or uses of the property by the owner
A change has occurred in that all or part of the property is now being offered for sale or lease.
All or part of the property is occupied by an organization other than the owner: the user organization(s) make payments for use of the property, and a change has occurred in (1) the proportions of the property so occupied, (2) the terms of the occupancy, or (3) the payments made by the occupant(s).
Physical changes in the property (such as construction, alterations, or demolition) have occurred.
A change has occurred in the nature or schedule of planned construction of buildings or other improvements on an unimproved portion of the property.
One of the organization's purposes is hospital, and a change has occurred in the amount of space or time that the property is used for the private practice of staff members or others rather than for the direct hospital related activities.
Statement of change - I hereby certify that all of the changes, as listed above, that have occurred since application for exemption was last filed have been noted and explanations of such changes are true and correct to the best of my knowledge and belief.
Statement of NO change - I hereby certify that none of the changes listed above have occurred since application for exemption was last filed to the best of my knowledge and belief.
Explanation of Changes
Signature
*
Title
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: