Form Rev 63 0001 - Application For Property Tax Exemption (Page 2 of 3) in pdf

Section 3 – Provide Acquisition and Use Dates

1. On what date did your organization acquire (purchase/lease) this property?

2. On what date did your organization begin using this property to conduct the exempt activity?

Applications should be submitted within 60 days of your organization’s acquisition of the property or within 60 days of the date

your organization began using the property to conduct an exempt activity, whichever is later. Applications received after the

60-day period expires are subject to a late filing penalty which accrues at a rate of $10 per month or portion of a month. If a

late filing fee is due, we will compute if for you and notify you of the amount during the application process.

Section 4 - Documentation Confirmation

Please indicate that the following required documentation is included with this application packet:

A copy of your Articles of Incorporation showing the stamp of the

Secretary of State

(include all amendments).

Churches Only: May submit a copy of their Bylaws or Faith Statement instead of stamped articles.

A copy of your IRS letter, if your organization has been granted exemption from federal income tax under section 501(c)

A copy of your most recent IRS Form 990 or a copy of your most recent annual income and expense statement*

*Financial information is not requested of Churches.

A copy of the deed for real property or a copy of the lease agreement if the property claimed is leased.

Note: A “Deed of Trust” cannot be used to demonstrate ownership. Please submit a warranty, quit claim or similar deed.

A parcel map and legal description (This information can be obtained from your county assessor’s office or their website.)

A site plan which identifies the location of buildings, parking, landscaping, and undeveloped areas (this information may

be obtained from your county assessor’s office or their website, from Google or Bing maps or you may provide a hand

drawn site map).

Pamphlets, brochures, and/or letter explaining the how the property claimed is being used.

() All additional documents listed in Section 6 of this application for the activity/exemption claimed.

If your organization rents/leases or allows other individuals, groups or organizations to use the property, please provide:

A copy of all rental or sub-leases, use agreements and occupancy agreements.

Section 5 - Certification & Refund Request

By signing this document I certify that I am an authorized representative of the applicant. 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 a part thereof, exempt from taxation. If a financial statement is attached, I

certify that the income (including donations) has been applied to the actual expenses of operation, maintenance and/or capital

expenditures of the property and to no other purpose. If applicable, I request a refund of property taxes under the provisions of

RCW 84.36.815 and RCW 84.69.020.

Signature

Date

Printed Name

Title

Contact Phone

Email Address

REV 63 0001 (6/2/15)

Form Rev 63 0001 - Application For Property Tax Exemption Page 2