Application For Property Tax Exemption
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Application for Property Tax Exemption
Chapter 84.36 RCW
This application should be completed by the organization that is actually conducting the activity on or using the property.
This area to be completed by Department of Revenue Only
Post Date:
Registration #:
County #:
Fee: $
Scan Date:
Website Address:
Name of Organization:
As shown this organization's Articles of Incorporation
Contact Person's Name and Title:
Phone:
Email:
Mailing Address:
City
State
Zip
Federal Employer ID # or Taxpayer ID #:
WA State UBI #:
DOR Registration #:
Address of the site/property under application:
City
County
State
Zip
Site Contact Person's Name and Title:
Phone:
Email:
I am applying for exemption of: (mark all that apply)
Personal Property Account #:
Owned Leased
Personal Property Tax
(equipment & furnishings)
Real Property Tax (land & buildings)
Owned Leased
Real Property Parcel #:
Leasehold Excise Tax
STATUTE: My organization is applying under RCW 84.36:
Enter Statue(s) from the Activity Matrix
On what date did your organization purchase or lease the property:
On what date did your organization begin using this property to conduct the exempt activity:
Does this property include a parsonage convent caretaker residence?
Yes
No
Was this property exempted for the previous owner or lessee?
Yes
No
Unknown
Does your organization allow other individuals or organization to rent/use the property?
Yes
No
Are any building under construction or remodel (currently or planned)?
Yes
No
I have reviewed pages 3 and 4 and have attached all documentation requested.
By signing this document I certify that I am an authorized representative of the applicant organization. I certify that the statements in this
application and the information attached are true and correct to the best of my knowledge and belief, and are made for the purpose of having
the property described here on or part there of, exempt from taxation. I certify that I have reviewed, and can produce upon request, a
statement of the receipts and disbursement of the applicant which shows that the income and receipts (including donations) have been applied
to the actual expenses of operating and maintaining the exempt activity or for its capital expenditures and to no other purpose. If applicable, I
request a refund of property taxes under the provisions of RCW 84.36.815, RCW 84.69.020 and RCW 84.69.030.
Signature:
_____________________________________________
Date:
________________
Title: ______________________________
Printed Name: _________________________________________
Phone:
________________
Email: ____________________________
REV 63 0001
Property Tax Division PO Box 47471 Olympia WA 98504‐7471 (360) 534‐1400
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