Pt 43 - Application For Property Tax Exempt Status (Sdcl 10-4-15)

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SD EForm - 1293
V3
APPLICATION FOR PROPERTY TAX EXEMPT STATUS (SDCL 10-4-15)
APPLICATION MUST BE FILED WITH DIRECTOR OF EQUALIZATION BY NOVEMBER 1
FOR CONSIDERATION DURING COUNTY BOARD OF EQUALIZATION THE FOLLOWING YEAR
STATE OF SOUTH DAKOTA
)
Assessed in the name of:
)
Mailing Address:
COUNTY OF ________________
)
Phone No.
Parcel Number___________________________
We, the undersigned hereby make application for (full) (partial) property tax exempt status in accordance with the provisions of state laws and regulations
and in support of this application make the following declarations under oath concerning the ownership and use of the property indicated below.
1.
Legal description of property (Use separate application form for each legal description)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
2.
Exemption is claimed under: (check one and give appropriate IRS tax exemption number and attachment of such)
______ SDCL 10-4-9 Religious Exemption
______ SDCL 10-4-9.1 Charitable Exemption - Federal 501(c)(3) exemption number ________________
______ SDCL 10-4-9.2 Benevolent Exemption
Federal 501(c)(3) exemption number __________ Federal 501(c)(10) exemption number __________
Federal 501(c)(7) exemption number __________ Federal 501(c)(19) exemption number __________
______ SDCL 10-4-9.3 Non-profit Health Care - Federal 501(c)(3) exemption number ________________
______ SDCL 10-4-13 Education Exemption - Accredited by ____________________________________
______ SDCL 10-4-9.4 Congregate housing * – Federal 501(c)(3) exemption number _______________________
* Congregate housing applications must also include a statement listing health care services provided and method used to satisfy
the balanced nutrition program
______ SDCL 5-14-23 Local Industrial Development Corporation
______ Multi-tenant Business Incubator – Federal 501(c)(3) exemption number _______________________
Federal 501(c)(4) exemption number _______________________Federal 501(c)(6) exemption number _______________________
______ Other (Give appropriate code cite) __________________________________________________
3.
Date of organization or incorporation _________________________
4.
Date and method of acquisition of property (Contract for deed, Warranty Deed, Quit Claim Deed, Other)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
5.
Specific uses of the property (exempt use as well as any nonexempt use)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
6.
What percent of property is used exclusively for religious, charitable, benevolent, health, educational
or other exempt purpose? _____________________________________________________________________________
7.
Itemize any income generated from this property ______________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
8.
Estimate of value of real property involved in this application:
Land _______________
Structures _______________
Amount of Insurance _______________
________________________________________ Subscribed and sworn to before me this ___ day of _____ 20__.
Signature / Title
_____________________________________________
(Notary Public)(Auditor)
RETURN ALL THREE COPIES TO THE DIRECTOR OF EQUALIZATION BY NOVEMBER 1
================================================================================================================
REPORT OF INVESTIGATION
(To be made by Director of Equalization to County Board of Equalization)
I hereby report I have investigated the statements made in the foregoing application as to the ownership and use of the property as of November 1, 20_____.
Based on the investigation it is my recommendation that this property be declared (EXEMPT), (TAXABLE) (_____ % TAXABLE) exempt effective November
first, following action by the county board of equalization.
_______________________________________________
_____________________________
(Director of Equalization)
(Date)
================================================================================================================
ACTION BY COUNTY BOARD OF EQUALIZATION
The County Board of Equalization has determined that the above property to be (EXEMPT), (TAXABLE), (_____%
EXEMPT) for the tax year 20____.
____________________________________________ County Auditor
Date __________________
APPEAL PROCESS: Appeal from your County Board may be taken to the State Office of Hearing Examiners. Such written notice must be filed with the Chief Hearing
Examiner, 210 E. Fourth, Pierre, South Dakota, 57501, no later than the third Friday in May (postmarked by deadline is considered timely). Appeals to the Circuit Court
may be taken from the county board or the Office of Hearing Examiners within thirty days from the publication of the decision. An appeal from the county board to circuit
court will prevent an appeal to the Office of Hearing Examiner. However, you may appeal the decision of the Office of Hearings Examiner to circuit court.
PT 43 (6/06)
Original: Director of Equalization
First copy: Department of Revenue
Second copy: Applicant
CLEAR FORM
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