Application For Property Tax Exemption For Nursing Homes And Boarding Care Homes

Download a blank fillable Application For Property Tax Exemption For Nursing Homes And Boarding Care Homes in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Application For Property Tax Exemption For Nursing Homes And Boarding Care Homes with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

CR-NBH
For Office Use Only
Approved
Name of organization _____________________________Assessment year ____________
Denied
Assessor’s signature ______________________________Date _______________________
Application for Property Tax Exemption for Nursing Homes and
Boarding Care Homes
Please read the instructions before you complete this form. Return to your county assessor by February 1.
To be completed by all applicants
Representative or Owner Last Name
First Name
Middle Initial
Title
Name of Organization
Mailing Address
City
State
Zip code
County
Parcel ID or legal description of property (from tax statement or valuation notice)
Certifications
I certify that the above organization is exempt from federal income tax under section 501(c)(3).
Yes
No
You must be able to certify one of the following as being true in order to qualify for the exemption:
I certify that this facility is certified to participate in the medical assistance program under
title 19 of the Social Security Act.
Yes
No
I certify that this facility does not discharge residents due to inability to pay.
Yes
No
Signature of Owner or Authorized Representative
By signing below, I certify that the above information is true and correct to the best of my knowledge, and I am the owner of the prop-
erty or authorized representative of the organization that owns the property for which exemption is being claimed.
Signature of Owner
Phone
Date
Include with this application a designation from the IRS proving status as a 501(c)(3) organization. Also include with this application
a copy of the facility’s discharge policy or proof that the facility is certified to participate in the medical assistance program under
title 19 of the Social Security Act.
(Rev. 11/13)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2