Form Rev 63 0001 - Application For Property Tax And Leasehold Excise Tax Exemption
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1
2State of Washington
Department of Revenue
Property Tax Division/Exempt Properties
APPLICATION FOR PROPERTY TAX AND
PO Box 47471
Olympia WA 98504-7471
LEASEHOLD EXCISE TAX EXEMPTION
Phone: (360) 570-5871
As provided in Revised Code of Washington 84.36
DEPARTMENT OF REVENUE USE ONLY
Reset This Form
Registration No:
Year Paid:
Print This Form
Fee Paid:
Penalty Paid:
Add Parcel:
Refund:
1. TYPE OF APPLICATION
2. REGISTRATION NUMBER FOR EXEMPT PROPERTY
FEES DUE
(If 1st time applicant, Dept. of Revenue will assign Reg. No.)
First time filing / Reinstatement of
Exemption...................................................
$35.00
Addition to Existing Exemption ...................
$35.00
Annual Renewal..........................................
$ 8.75
3. EXEMPTION CLAIMED AS A (List statute number(s). See
There is a late filing penalty of $10 per month if filed
pages 4-6.)
after March 31.
4. APPLICANT (Non-profit organization name)
5. OCCUPANT (Non-profit organization name)
Mailing Address
Street Address of Property (Not PO Box) (See Instructions, page 3.)
City
State
City
County
State
Zip Code
Phone No.
Zip Code
Phone No.
6. EXEMPTION REQUESTED FOR:
REAL PROPERTY (Buildings & Lands)....................................
Owned by Applicant
Leased by Applicant
PERSONAL PROPERTY (Furnishings & Equipment) .............
Owned by Applicant
Leased by Applicant
LEASEHOLD (Lease of Gov’t Owned Property)
Government Owner
7. LEGAL DESCRIPTION OF REAL PROPERTY AS USED BY THE COUNTY ASSESSOR
County Assessor’s Parcel No.
County Assessor’s Legal Description
Describe how each parcel of property is
(Attach additional sheets if necessary.)
used
(Attach additional sheets if necessary.)
Yes
No
If yes, complete this section.
8. ARE BUILDINGS PLANNED OR UNDER CONSTRUCTION?
Proposed beginning date of construction
Date construction was started
Proposed date of completion
ATTACH ACCURATE SITE PLAN
9. DATE PROPERTY WAS ACQUIRED
Original date property was actually used for exempt purpose
10. WAS THIS PROPERTY PREVIOUSLY EXEMPT?
11. NAME OF PREVIOUS OWNER
Yes
No
REV 63 0001-1 (12/1/04)
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Parent category: Financial