Application For Exemption From Real Estate Taxation For Property Owned By Nonprofit Organizations

Real Estate Tax Exemption Application for Nonprofit Organizations

Page 4

S E C T I O N 6 - O R G A N I Z A T I O N S T A T E M E N T O F A S S E T S A N D L I A B I L I T I E S F O R L A S T F I S C A L Y E A R

COMPLETE ONLY IF SECTION 3, QUESTIONS 1 OR 5 WERE ANSWERED "NO."

M M Beginning date M M

M M Ending date M M

ASSETS

1. Cash

(a) interest bearing accounts...............................................................................................................

1a.

(b) other...............................................................................................................................................

1b.

2. Accounts receivable, net ......................................................................................................................

3. Inventories............................................................................................................................................

4. Bonds and notes

.........................................................................................................

(attach schedule)

5. Corporate stocks

............................................................................................................

(attach schedule)

6. Mortgage loans

...........................................................................................................

(attach schedule)

7. Other investments

......................................................................................................

(attach schedule)

8. Depreciable and depletable assets

.............................................................................

(attach schedule)

9. Land .....................................................................................................................................................

10. Other assets

..............................................................................................................

10.

(attach schedule)

11. TOTAL ASSETS (add lines 1 through 10)............................................................................................

11.

LIABILITIES

12. Accounts payable.................................................................................................................................

12.

13. Contributions, grants, etc. payable ......................................................................................................

13.

14. Mortgages and notes payable

....................................................................................

14.

(attach schedule)

15. Other liabilities

...........................................................................................................

15.

(attach schedule)

16. TOTAL LIABILITIES (Add lines 12 through 15)...................................................................................

16.

FUND BALANCE OR NET WORTH

17. Total fund balance or net worth ..........................................................................................................

17.

18. TOTAL LIABILITIES AND FUND BALANCE OR NET WORTH (line 16 plus line 17) .........................

18.

19. Has there been any substantial change in any aspect of the organization's financial activities since

I I

the period ended, as shown above?..............................................................................................................................

YES

IF "YES," ATTACH A DETAILED EXPLANATION.

A F F I D A V I T

STATE OF NEW YORK

SS:

COUNTY OF

___________

_________________________________ ___________________ being duly sworn, says under penalty of perjury

that he/she is the owner/applicant or the __________________________________________ of the owner/applicant(s), that the

statements contained in this application, including any attachments to this application, are true to his/her knowledge.

Signature of APPLICANT OR REPRESENTATIVE

Subscribed and sworn to before me this