Form 150-310-088 - Application For Real And Personal Property Tax Exemption - 2013

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Application for Real and Personal Property Tax Exemption

For property owned by specific institutions and organizations [Oregon Revised Statute (ORS) 307.162]

• File this form with the county assessor on or before April 1 for the ensuing tax year. Include documents that clarify that the entity and

use of the property meet the requirements for exemption. See page 3 of this form for late filing information.

• See ORS 307.162 and OAR 150-307.162 on pages 2 and 3 of this form.

• This form is available online on the Department of Revenue’s website at:

Name of organization

For assessor’s use only

Account number

Date received

Mailing address

Telephone number

Late filing fee

Approved

Denied

City

State

ZIP code

By ____________________

20 _______ – __________

Exemption applies to tax year :

A property tax exemption is requested under the following Oregon Revised Statute (mark one box):

c 307.110 Government owned affordable housing

307.145 Child care facilities, schools, student housing*

c 307.130 Literary, benevolent, charitable, scientific

307.147 Senior services centers*

institutions, volunteer fire departments*

307.150 Burial grounds, cemeteries, crematory

c 307.136 Fraternal organizations*

307.160 Public libraries*

c 307.140 Religious organizations*

Other (provide ORS number)________________________

*You must attach current copies of your organization’s Articles of Incorporation, By-Laws, and proof of your status as a

non-profit corporation or other qualifying organization.

Property description

Account number (as shown on owner’s property tax statement)

Physical address (street address, city)

List all real property for which an exemption is claimed. Is personal property owned by the organization at this location also being claimed?

c Yes

c No

Property use

If you change the stated use of the property to a use that would not qualify for exemption, you must notify the county assessor of this

change to a taxable use within 30 days of the change in use.

Describe the purpose of this organization:

Describe how you will use the property, e.g., church services, offices, classrooms, student housing, etc.:

Does the property include

What is the fee for using

Yes

a parking area?

the parking area?

Is any portion of the property

If yes, what is the square footage of

Yes

leased to or used by others?

the area used by others:

________________

square feet

If yes, explain and identify the area that is used by others:

Late fee

A form filed after April 1 preceding the tax year for which exemption is claimed, but on or before December 31 of the tax year must be accompanied by

a late fee. See page 2 and 3 of this form for additional late filing information.

Exemption requested for tax years:

A late fee is attached:

Yes

_________________

Declaration

I declare under the penalties for false swearing [ORS 305.990(4)] that I have examined this document (and attachments) and to the best of my knowledge

they are true, correct, and complete.

must be signed by the president, proper officer, head official, or authorized delegate of the organization

Name (please print or type)

Title

Telephone number

Signature

Date

150-310-088 (Rev. 12-13)