Form 50-286 - Lessor'S Application For Personal Use Lease Automobile Exemption Page 3

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P r o p e r t y T a x

L e s s o r ’ s A p p l i c a t i o n f o r P e r s o n a l U s e L e a s e A u t o m o b i l e E x e m p t i o n

Form 50-286

Schedule A: List of Leased Vehicles

_____________________________________________________________

__________________________________

Name of Lessee

Phone (area code and number)

______________________________________

____________________________________

___________________

Mailing Address

City, State, ZIP Code

County

______________________________________

____________________________________

___________________

Address Where Vehicle is Kept

City, State, ZIP Code

County

______________________________________

_________________

________________

___________________

Vehicle Identification Number

Year

Make

Body Style Type

______________________________________

_________________

________________

Model

Weight**

Lease Date

Has the lessee signed an affidavit designating the vehicle as not held for income production and not used for the



production of income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes



Has the property owner maintained the lessee’s affidavit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

_____________________________________________________________

__________________________________

Name of Lessee

Phone (area code and number)

______________________________________

____________________________________

___________________

Mailing Address

City, State, ZIP Code

County

______________________________________

____________________________________

___________________

Address Where Vehicle is Kept

City, State, ZIP Code

County

______________________________________

_________________

________________

___________________

Vehicle Identification Number

Year

Make

Body Style Type

______________________________________

_________________

________________

Model

Weight**

Lease Date

Has the lessee signed an affidavit designating the vehicle as not held for income production and not used for the



production of income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes



Has the property owner maintained the lessee’s affidavit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

_____________________________________________________________

__________________________________

Name of Lessee

Phone (area code and number)

______________________________________

____________________________________

___________________

Mailing Address

City, State, ZIP Code

County

______________________________________

____________________________________

___________________

Address Where Vehicle is Kept

City, State, ZIP Code

County

______________________________________

_________________

________________

___________________

Vehicle Identification Number

Year

Make

Body Style Type

______________________________________

_________________

________________

Model

Weight**

Lease Date

Has the lessee signed an affidavit designating the vehicle as not held for income production and not used for the



production of income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes



Has the property owner maintained the lessee’s affidavit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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50-286 • 09-11/2 • Page 3