Form 50-115 - Application For Charitable Organization Property Tax Exemption Page 2
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550-115 (Rev. 8-03/8) - Page 2
Step 3:
Operates a television station that produces or broadcasts educational, cultural or other public interest
Answer these
questions
programming and that receives grants from the Corporation for Public Broadcasting. [47 U.S.C.A. sec. 396*] .......
about the
organization
Provides housing and services to people 62 years old or older in a retirement community that provides
(continued)
independent and assisted living services and nursing services to residents on a single campus, without
regard to ability to pay or in which at least 4 percent of community’s combined net resident revenue is
provided in charitable care to its residents. ................................................................................................................
Provides housing for low-income and moderate-income families, for unmarried individuals 62 years old or
older, for handicapped individuals, and for families displaced by urban renewal, through the use of trust
assets irrevocably dedicated, through a contract entered into before December 31, 1972, for the sale of
housing to a charitable organization performing the athletic development of boys and girls under 18 years.* .........
Provides for the organized solicitation of gifts and grants to non-profit human services organizations.
If this function is checked, answer the following questions. .................................................................................
Yes
No
a. Does the organization have a volunteer board of directors? .............................................
b. Is the organization affiliated with a state or national organization that authorizes,
Yes
No
approves or sanctions volunteer fundraising organizations? ............................................
c. Does the organization qualify for exemption under Sec. 501(c)(3), Internal Revenue
Yes
No
Code, as amended? ...........................................................................................................
d. Does the organization distribute contributions to at least five other organizations
which (1) use the funds for charitable purposes; (2) are governed by volunteer
boards of directors; (3) qualify for exemption under Sec. 501(c)(3), Internal Revenue
Code, as amended; (4) receive a majority of their revenue from charitable gifts and
government agencies; and (5) provide services without regard to their beneficiaries’
Yes
No
ability to pay? If yes, attach a list of organizations. .........................................................
Performs biomedical or scientific research or scientific education for benefit of the public.* ....................................
* A corporation that performs a function that is marked with an asterisk(*) does not have to be organized as a
non-profit corporation.
** A charitable organization that performed this function must engage primarily in performing the described function,
but may engage in other activities that support or are related to its charitable functions.
3. Does the organization perform, or does its charter permit it to perform, any functions other than
those checked in question 2? ............................................................................................................
Yes
No
If “YES,” attach a statement describing the other functions in detail.
4. In the past year has the organization loaned funds to, borrowed funds from, sold property to or
bought property from a shareholder, director or member of the organization, or has a shareholder
or member sold his interest in the organization for a profit? .............................................................
Yes
No
If “YES,” attach a description of each transaction. For sales, give buyer, seller, price paid, value
of the property sold and date of sale. For loans, give lender, borrower, amount borrowed,
interest rate and term of loan. Attach a copy of note, if any.
5. Attach a list of salaries and other compensation for services paid in the last year. Also list any funds distributed to members,
shareholders or directors in the last year. In each case, give recipient’s name, type of service rendered or reason for payment
and amounts paid.
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