Form Fp 161 - Exempt Property Use Report - 2012

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GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF TAX AND REVENUE
R
P
T
A
EAL
ROPERTY
AX
DMINISTRATION,
th
1101 4
STREET, SW, SUITE W550
W
, DC 20024
ASHINGTON
EXEMPT PROPERTY USE REPORT (FORM FP 161)
Square:
Suffix:
Lot:
________ _
Reporting Year:
(Calendar Year for Category I Filers; Real Property Tax Year
for Category II Filers)
You should read instructions before attempting to complete this Form.
PART I—ALL FILERS MUST COMPLETE
Name and mailing address of exempt institution or organization:
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ______________________________ State: ___________________ Zip: _________________
Location of property (property’s street address): ____________________________________________
1. Type of institution or organization (e.g. religious, educational, charitable, etc.): _________________
____________________________________________________________________________
2. State, in detail, how the exempt property, identified by the square and lot or parcel and lot, was used
during the reporting year indicated above. Include both buildings and grounds:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3. Was any building, structure, or grounds, or any portion thereof used by the institution or organization,
or the occupant thereof, to secure direct, indirect, or in-kind rent or income during the reporting year?
O Yes
O No

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