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13. Gross income from unrelated trade or business:

State the gross income derived by the owner from any use of the property for an unrelated trade or business, as determined pursuant to sections 511 to

513 of the Internal Revenue Code, during the past twelve months, or that portion of the past twelve months that the property was owned by your

If the owner did not

organization. This should include all unrelated trade or business income derived from activities listed under Number 12 above.

receive any such income from this property during this period, please state "NONE". [$_______________]

14. Gross rental income from non-exempt uses:

State the gross rental income received by the owner for the use of the property for nonqualifying purposes during the past twelve months, or for that

portion of the past twelve months that the property was owned by your organization. This should only include gross rental income received from all

If the owner did not receive any such income from this property during this period, state

uses listed in Number 12 above.

"NONE". [$_________]

15. Number of hours property was used for non-exempt purposes:

State the number of hours that this property was used for purposes other than religious purposes, strictly charitable purposes, or schools, during the

past twelve months, or that portion of the past twelve months that the property was owned by your organization. This should include the number of

hours that the property was used by the groups listed in Number 12 above. Hours may be adjusted for partial use according to the formula listed in

If there were no such uses of the property, please state "NONE": [_________________] HOURS.

Rule I.B.27.

16. Signature and verification:

I declare, under penalty of perjury in the second degree, that I have examined this application, including any attachments,

and to the best of my knowledge and belief, it is true, correct and complete.

SIGNATURE_____________________________________________________ DATE____________________________

NAME OF SIGNATORY____________________________________________ TITLE____________________________

IMPORTANT REMINDERS:

1) Failure to supply complete or accurate information may result in denial. Please review your answers before mailing.

2) Be sure to provide information for all portions of the property, including any vacant/unimproved areas.

3) A separate application and fee is required for each parcel of real property, or for each tax area for personal property.

Consult your assessor if unsure how many parcels/tax areas are involved.

4) This application must be submitted through your County Assessor. Failure to do so will result in substantial delays in

processing your request.

5) We cannot review your request until the filing fee is paid in full.

This Portion to be Completed by the County Assessor

Please complete each of the following questions with respect to the subject property. Forward the original of the

application form and the supporting documents to the Division of Property Taxation, along with the applicant's check.

Retain one copy of the application for your files. You will be notified when a determination is reached.

A. Date application was received in your office: ______/______/______

B. Legal description (item #4) or location of personal property (item #5)

is correct

is incorrect.

If incorrect, please provide correct information: ________________________________________________________

______________________________________________________________________________________________

C. Name of owner (item #7)

is correct

is incorrect.

If incorrect, state correct name of owner:

______________________________________________________________________________________________

D. Date deed recorded _____/______/______ in book __________ page ___________

E. Parcel I.D. No(s):__________________________ _____________________________ _______________________

(If more than one parcel, please identify each parcel by legal description.)

F. Tax Area(s):

__________________________ _____________________________ _______________________

(If more than one, please identify which locations are in which tax areas.)

G. ACTUAL value is: Land $_________________ Improvements $________________ Personal $________________

H. PLEASE PROVIDE COPIES OF THE PROPERTY ASSESSMENT CARD AND A PLAT OF THE AREA.

Date: ______/______/______ COUNTY ASSESSOR:_____________________________________________________

BY:[____________________________________________________]

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Form 901-B - Application For Exemption Of Property Owned And Used For Religious Purposes - Colorado Division Of Property Taxation Page 3

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