Application For Property Tax And Leasehold Excise Tax Exemption Form - Washington Department Of Revenue Page 2

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Yes
No
12. IS ANY PORTION OF THIS PROPERTY LEASED, RENTED, OR LOANED TO OTHERS?
(Attach Separate List If Necessary.)
Sq. Footage of Bldg. or
What Activities does
How Much Rent or
For What Purposes are
To Whom Leased,
Portion of Prop. Used
Renter Conduct on this
Other Donations are
the Rents or Other
Rented, or Loaned
by Renter
Property?
Received from Renter?
Considerations Used?
Day/Wk/
Amount
Yr/etc.
A
Per
Day/Wk/
Amount
Yr/etc.
B
Per
Day/Wk/
Amount
Yr/etc.
C
Per
13.
I certify that I am the authorized agent of the legal owner and that the information provided is accurate. Further, if law
requires a financial statement, 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.
(
)
Signature
Daytime Telephone
(
)
Contact Person (Print)
Daytime Telephone
Office Hours / E-mail address, if any
Date
THIS APPLICATION WILL BE DELAYED IF NOT COMPLETE
Filing Period - Applications for property tax exemption must be filed with the Department of Revenue between
January and March 31 each year, or within 60 days of acquisition or conversion of the property to an exempt
use. Applications that are filed after the deadline are subject to late filing penalties.
Fees - The application fee is $35.00.
A late filing penalty of $10.00 per month or portion of a month shall be collected before the Department of
Revenue will consider any claim for property tax exemption when the completed application is filed after the
due date.
Effective Date - If the property is determined by the Department of Revenue to be exempt, the taxes due in the
year following the year of application will be exempted. Example: Application is made in March 2000 shortly
after exempt activity begins. If the property is found to be exempt, the taxes due and payable in 2001 are
exempted.
Notification of Exemption - When the Department of Revenue has completed the processing of your
application, a written determination will be issued to you and to the county assessor to adjust their records.
Generally, a determination is made by July 31 or within 60 days, whichever is later.
To inquire about the availability of this form in an alternate format for the visually impaired, please call (360) 753-3217. Teletype
(TTY) users please call (800) 451-7985. You may also access tax information on our Internet home page at
RETAIN A COPY FOR YOUR RECORDS
REV 63 0001-2 (6/01/00)

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