Application For Property Tax Exemption Form - Randolph County Tax Department

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RANDOLPH COUNTY TAX DEPARTMENT
APPLICATION FOR PROPERTY TAX EXEMPTION
NOTE: Application must be filed with the Tax Department by February 1
of the current year.
st
SECTION 1
The undersigned owner or authorized representative hereby petitions for exemption for the following described property beginning
January 1, 20____.
1. Owner
_______________________________________________ Date _____________________________________
Address ___________________________________________________________________________________________
___________________________________________________________________________________________
2. Location of property _________________________________________________________________________________
3. Upon what uses or purpose do you base this claim for exemption of property taxes?
Religious
YES [
]
NO [
] - (Please complete Section 2)
Charitable
YES [
]
NO [
]
"
"
"
Educational
YES [
]
NO [
]
"
"
"
Literary
YES [
]
NO [
]
"
"
"
Scientific
YES [
]
NO [
]
"
"
"
Other
YES [
]
NO [
] - (Please add a written statement to support the claim for exemption)
SECTION 2
Please give an answer for all items:
1. Total number of lots or acres in this tract: ________________.
INSTRUCTIONS FOR ITEMS 2A - 2E: BUILDINGS & IMPROVEMENTS
2.
A. Below in Section A, give the approximate size and description of the building(s) on this land.
B. Below in Section B, give the number of lots or acres occupied by the building(s) and any additional adjacent land
reasonably necessary for the convenient use of each building.
C. Below in Section C, describe how the building was used on January 1 of this year and is currently in use for worship or
activities that demonstrate and further the beliefs and objectives of a given church or religious body, or for nonprofit
educational, scientific, literary, or charitable purposes.
D. Below in Section D, state whether the building and land are being used completely and exclusively by the owner for the
purpose as stated in Section 1, item 3.
E. Office use only.
PLEASE GIVE CLEAR AND COMPLETE ANSWERS
____________________________________________________________________________________________________
Section A
B
C
D
E
____
Building Size
Land
Building &
Exclusive Use
Office
& Description
Size
Land Use
Yes/No
Use
_____
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3.
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4.
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