Nonprofit Housing and Care to Elderly
Clear Form
Application for Funded Property Tax Exemption
Oregon Revised Statutes 307.241 to 307.245
Date received
• File 2 copies with your county assessor on or before April 1.
• See information on back for explanations.
1.
Name of corporation
County Assessor’s Certification
Signature
DBA
This application is:
Approved
Title
Date
Address
Denied
State
J.V. number
City
ZIP code
Reason if denied
2.
Assessor’s account number (as shown on property tax statement)
Property
Area code number
Description
Deed volume and page or instrument number
Date recorded
Lot(s)
Block(s)
Addition
Subsection
Section
Twp.
Rge.
Acres
3. An exemption is requested on the above-described property which is used as nonprofit housing, recreational and social facilities, and
care to the elderly. Attach one copy of the following documents to support the request:
a. Statement showing current rents certified by U.S. Department of Housing and Urban Development or Oregon Housing Agency.
b. Statement of total income of nonprofit home: 1) Listing rent for each unit, 2) leased or rented commercial area, and 3) income from
any other source.
4.
Is this your first time applying for an exemption under this statute? Yes No
If NO, when did you last apply? __________________________ Was the exemption approved? Yes No
If exemption was denied, list reason(s) for denial: _________________________________________________________________________
If exemption was approved, the rent as certified by the U.S. Department of Housing and Urban Development (HUD) or Oregon Housing
Agency (OHA):
Does* Does not** contain an amount for property taxes.
*Attach a three-column listing showing: 1) individual living unit rents, as certified by the government agency, 2) the amount each rent was reduced in the
previous year to reflect the tax exemption, and 3) a list of current rents, by each living unit.
** Attach a letter, signed by a representative of HUD or OHA, stating that the rents do not contain property taxes.
5.
Federal or state financial assistance (such as a loan, mortgage
Section 202 of Title II (12 USC 1701q)
insurance, aid to construction, rent supplement) is received or
Section 236 [12 USC 1715z(1)]
has been received under the following federal and state laws:
Section 231 of Title II (12 USC 1715v)
Section 101 of Title II (12 USC 1701s) or
Section 8 of Title II (42 USC 1437f)
ORS 456.515 to 456.547
6.
When was the land acquired? _______________________________ When did the process of construction of improvements on land
begin? ____________________________ When did the improvements become occupied and used (wholly or partially) to furnish per-
manent residential, recreational and social facilities; and primarily for elderly persons? __________________________________
7.
Is this corporation organized and operated under the requirements of ORS 307.375? Yes No
[See reverse side under B(1–4 for explanation.]
8.
Is payment in excess of one month’s rent required as a condition to occupy the facility? Yes No
If so, what type of payment(s) and what amount for each? ___________________________________________________________
I declare under the penalties for false swearing [ORS 305.990] that I have examined this document and attached statements and to
the best of my knowledge it is true, correct, and complete.
Signature
Title
Telephone no.
Date
X
150-310-091 (Rev. 08-10)