Form 62a023 - Application For Exemption From Property Taxation
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562A023 (4-10)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
APPLICATION FOR EXEMPTION
Offi ce of Property Valuation
Phone: 502-564-8338
FROM PROPERTY TAXATION
Fax: 502-564-8368
This application is to be used by organizations seeking property tax exemption pursuant to Section 170 of the Kentucky
Constitution. Answer all questions as fully as possible and return the application and all attachments to the Offi ce of Property
Valuation, 501 High Street, Frankfort, Kentucky 40620 or the local Property Valuation Administrator.
(
)
Name
(
)
(Print)
Enter Exact Legal Name of Organization
Daytime Offi ce & Cell Phone Numbers
Property
Location
(Print)
Number and Street
City
County
State
ZIP Code
Mailing Address
(If Different from Above)
(Print)
P.O. Box or Number and Street
City
County
State
ZIP Code
E-mail Address
Web Site:
Purpose of the
Organization and
Major Activity of
Applicant
State of
Nonprofi t
LLC
Other _________________________
Incorporation
State
County(ies) in
Which Property
is Located
Type of
Public Property
Institution of Education
Religious
Exemption
(check)
Place of Burial
Institution of Purely Public Charity
For this property tax exemption application, I authorize the Department of Revenue (DOR) or its representative(s)
to visit and inspect the property to be exempted now and in the future, to ensure the property is being used for tax-
exempt purposes. I hereby certify that the statements and information contained herein are correct to the best of my
Applicant
knowledge and belief and that I am authorized to sign this application.
Authorization
and Signature
Signed ______________________________________________
Title _________________________________________
Print ________________________________________________
Cell Phone Number ___________________________
Date ________________________________________________
Recommendation ____________________________________________________________________________
To be
____________________________________________________________________________________________
Completed by
____________________________________________________________________________________________
the Property
Valuation
Administrator
Signed ___________________________________________ Date _____________________________________
Print _____________________________________________
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