Form Fp 161 - Exempt Property Use Report (Page 2 of 3) in pdf

Form Fp 161 - Exempt Property Use Report Page 2

5a. If yes, give details. Please refer to enclosed instructions, numbers 7. ___________________

____________________________________________________________________

State the square footage of the space provided, the tenant’s name, the period of time the space

was used to secure rent or income, and the amount of rent. _____________________________

____________________________________________________________________________

6. Since last year has the use of any building or grounds, or any portion thereof, changed?

O Yes

O No

6a. If yes, give details. _________________________________________________________

____________________________________________________________________________

7. Were any buildings or structures added, altered, or removed during the year?

O Yes

O No

7a. If yes, give details. __________________________________________________________

_____________________________________________________________________________

AFFIDAVIT

Under penalties of law, I declare that I have examined this report, and the statements made herein are true and complete

knowledge, information, and belief.

to the best of my

Signature

______________________________

Name

___________________________

Title

_________________________________

Daytime Phone No.

______________________________

FP 161 (Rev. 04/10)

Form Fp 161 - Exempt Property Use Report Page 2