Form Rp-485-A - Application For Real Property Tax Exemption For Residential-Commercial Urban Exemption Program Page 2

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RP-485-a (1/05)
2
10. Other exemptions.
a. Is the property receiving or has it ever received any other exemption from real property taxation?
Yes
No
b. If yes, what exemption was received? __________________
When? _________________
Were payments in lieu of taxes made during the term of that exemption? ___________________
If so, attach a schedule showing the amounts and dates of such payments, and the purposes for
which such payments were made (i.e., school district, general municipal, etc.). Also attach any
related documentation, such as a copy of the agreement under which such payments were made.
CERTIFICATION
I, ____________________________________, hereby certify that the information on this application and
any accompanying pages constitutes a true statement of facts.
____________________________________
______________________
Signature
Date
Clear Form
FOR ASSESSOR’S USE
1. Date application filed: ______________
2. Applicable taxable status date: ________________
3. Action on application:
Approved
Disapproved
4. Assessed valuation of parcel in first year of exemption: $ _______________________
5. Increase in total assessed valuation in first year of exemption: $______________________
6. Amount of exemption in first year:
Percent
Amount
County
__________________
$ __________________
City/Town
__________________
$ __________________
Village
__________________
$ __________________
School District
__________________
$ __________________
______________________________________________
_________________________
Assessor’s signature
Date

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