Form Pv-Ad-1 - Annual Claim For Exemption From Property Taxation
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2
3ANNUAL CLAIM FOR EXEMPTION FROM PROPERTY TAXATION
To Be Filed with the County Appraiser on or before March 1st
See other side for instructions
Name & Address of Taxpayer:
County:
___________________
_____________________________________
Parcel I.D. No.:
___________________
_____________________________________
Personal Prop No.: ___________________
_____________________________________
Tax Year:
___________________
County Use Only
Description on file
Check if Yes
If Yes mail copy of form and written statement to PVD
NOTICE
This Annual Claim for Exemption by law must be accompanied by:
(1)
A Written Statement See instructions, other side and
(2)
A Description/List of Exempt Property See instructions, other side
1.
I (we) __________________________________, do hereby file a claim for property tax exemption for the tax
year ______, on the attached list of property.
2.
The basis for the exemption is:
Board of Tax Appeals Order, Docket No. ________________________.
3.
The Board Order indicates that the property is exempt pursuant to:
A. K.S.A. 79-201a Second (Industrial Revenue Bond-Funded Property)
B. Article 11, Section 13 of the Kansas Constitution
C. K.S.A. 79-221 (Certain Leased Property)
D. Other _____________________________ (explain).
4.
The period of exemption set forth in the Board’s Order is:
________________________ through _____________________.
5.
If the property is only partially exempt or if a payment in lieu of tax must be made, please attach the agreement
and/or uniform policy setting forth the terms.
6.
Are you filing a claim for any property acquired after the Board of Tax Appeals issued the order exempting
disclosed in number 2 above? ________. If yes, please explain why you believe this property is exempt.
7.
Has the ownership of the property for which you are filing a claim for exemption changed in the past year?
______________. If yes, attach a full explanation.
8.
Has the use of the property for which you are filing a claim for exemption changed in since the Board determined
that it was exempt? _____________. If yes, attach a full explanation.
I do hereby assert that the information furnished by me herein and in the attached schedules is
true, accurate, and complete.
Applicant’s Signature
________________________________
Date:
_______________
Name & Title
________________________________
Phone:
_______________
PV-AD-1
(Rev. 6/2014)
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