Form 50-128 - Application For Miscellaneous Property Tax Exemptions Page 4

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P r o p e r t y T a x
A p p l i c a t i o n f o r M i s c e l l a n e o u s P r o p e r t y T a x E x e m p t i o n s
Form 50-128
Schedule A: Description of Real Property
• Complete one Schedule A form for EACH parcel qualified for exemption.
• Attach all completed schedules to your application for exemption.
______________________________________________________________________
___________________________
Name of Property Owner
Appraisal District Account Number (if known)
Legal description of property:
Describe the primary use of this property:
1. Is this property used exclusively for charitable purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Is this property held for gain, rented or used with a view to profit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
3. Is this property the organization’s state headquarters? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
4. Is this property reasonably necessary for operation of the association/organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
5. Is this property located in a medical center area where the organization has donated land to the state for hospital
or medical school? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If “YES,” is the medical center development complete? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
6. Is the property currently under active construction or physical preparation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
_______________________
A. If under construction, when will construction be completed? (date)
**
B. If under physical preparation, check which activity the organization has done. (Check all that apply.)
Architectural work
Soil testing
Site improvement work
Engineering work
Land clearing activities
Environmental or land use study
7. Is the incomplete improvement designed and intended to be used by a qualified person for a purpose described by
Section 11.23 (a)-(e), (g), or (i)-(k)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
8. Is the land on which the incomplete improvement is located necessary for the use of the improvement for a purpose
named in Question 7 above? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
List all other individuals and organizations that used this property in the past year, and give the requested information for each.
Name
Dates Used
Activity
Rent Paid, If Any
Continue on additional sheets as needed.
**
An incomplete improvement exempted for the three years preceding the 2003 tax year is entitled to exemption for the 2003 tax year regardless of whether the property owner applies
for the exemption for the 2003 tax year if the property otherwise qualifies. The chief appraiser may require the property owner to file an application to confirm the owner’s qualification
for exemption for the 2003 tax year. An exemption for an incomplete improvement is for five years. Effective January 1, 2006, the exemption will revert back to three years.
For more information, visit our website:
Page 4 • 50-128 • 08-11/12

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