Application For Property Tax And Leasehold Excise Tax Exemption Form - Washington Department Of Revenue

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State of Washington
APPLICATION FOR PROPERTY TAX AND
Department of Revenue
Property Tax Division/Exempt Properties
LEASEHOLD EXCISE TAX EXEMPTION
PO Box 47471
Olympia WA 98504-7471
Phone: (360) 570-5871
As provided in Revised Code of Washington 84.36
DEPARTMENT OF REVENUE USE ONLY
Registration No:
Year Paid:
Fee Paid:
Penalty Paid:
Refund:
Add Parcel:
1. TYPE OF APPLICATION
FEES DUE
2. REGISTRATION NUMBER FOR EXEMPT PROPERTY
(If 1st time applicant, Dept. of Revenue will assign Reg. No.)
First time filing / Reinstatement of
Exemption .........................................
$35.00
Addition to Existing Exemption............
$35.00
____
____
____
____
____
____
____
____
Annual Renewal .................................
$ 8.75
3. EXEMPTION CLAIMED AS A (List statute number(s). See
There is a late filing penalty of $10 per month if filed
pages 4-6.)
after March 31.
4. APPLICANT (Non-profit organization name)
5. OCCUPANT (Non-profit organization name)
Mailing Address
Street Address of Property (Not PO Box) (See Instructions, page
3.)
City
State
City
County
State
Zip Code
Phone
Zip Code
Phone
(
)
(
)
6. PERSONAL PROPERTY IS
OWNED
LEASED
If leased, provide description of property and attach a copy of the lease agreement.
7. LEGAL DESCRIPTION OF REAL PROPERTY AS USED BY THE COUNTY ASSESSOR
County Assessor’s Parcel Number
County Assessor’s Legal Description
Describe how each parcel of property is
(Attach additional sheets if necessary.)
used
(Attach additional sheets if necessary.)
8. ARE BUILDINGS PLANNED OR UNDER CONSTRUCTION?
Yes
No
If yes, complete this section.
Proposed beginning date of construction
Date construction was started
ATTACH ACCURATE SITE PLAN
Proposed date of completion
9. DATE PROPERTY WAS PURCHASED
Original date property was actually used for exempt purpose
10. WAS THIS PROPERTY PREVIOUSLY EXEMPT?
11. NAME OF PREVIOUS OWNER
Yes
No
REV 63 0001-1 (6/01/00)

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