Application For Exemption Governmentally Owned Property Form
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1MARYLAND STATE DEPARTMENT OF ASSESSMENTS AND TAXATION
Return to your local Assessment
office; a list of offices is attached.
APPLICATION FOR EXEMPTION
GOVERNMENTALLY OWNED PROPERTY
TO BE FILED IN DUPLICATE with the Supervisor of Assessments in the appropriate local office.
Full Name of Titled Owner:
___________________________________________________________________________
Address of property:
________________________________________________________________________________
______________________________________________________________________________________________________
Date Acquired:
Account number:
____________________________
__________________________________________
Location and description of property:
Baltimore City
Ward
Section
Block
Lot
Counties
District
Map
Block
Parcel
1. What type of facilities and number of buildings are located on the property?
(Be specific and you may attach
a separate itemization if more space is required.)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
2. What limitations or restrictions apply concerning who may use each separate facility?
(A supplemental
explanation sheet may be attached.)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
3. Is any part of this property rented? Yes
No
________
_________
If yes, to whom?__________________________________________ What is the estimated annual rent?_________________
4. Does the applicant organization own any adjoining real property? Yes
No
________
_________
I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, of the Annotated
Code of Maryland, that this return (including any accompanying schedules and statements) has been
examined by me and to the best of my knowledge and belief is a true, correct and complete return.
____________________________________________________________________
____________________________
SIGNATURE OF APPLICANT
DATE
__________________________________________________________________
_________________________________
ADDRESS
PHONE
_______________________________________________________________
CITY
STATE
ZIP CODE
(FOR OFFICE USE ONLY)
COMMENTS:___________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
New Application_______________
Re-Application______________
Code No.______________________
Approved_________________
Disapproved____________
Effective______________________
Land
Improvements
Total
__________________________________________________________
_______________________________
Supervisor's Signature
Date
__________________________________________________________
_______________________________
State Supervisor's Signature
Date
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION
SDAT - EX 6A
Re: 3/2014
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