Form 150-310-089 - Application For Property Tax Exemption For Rural Health Care Facility
ADVERTISEMENT
1APPLICATION FOR PROPERTY TAX EXEMPTION
For Rural Health Care Facility
Exemption for ________________ tax year
• File with your county assessor on or before April 1.
FOR ASSESSOR’S USE ONLY
See Oregon Laws 2001, Chapter 642.
Date Received
Organization Name
Account No.
Late Filing Fee
Organization Address
Telephone Number
$
(
)
Exemption
Approved
Denied
City
State
ZIP Code
begins
–
By
in tax year 20
Name of Applicant
Telephone Number
(
)
Mailing Address (if other than organization address)
City
State
ZIP Code
PROPERTY DESCRIPTION
Assessor’s Account Number (as shown on property tax statement)
Name of Property Owner
Property Address (street address, city)
FACILITY INFORMATION
Attach a copy of resolution or ordinance.
Date construction, erection, or installation is to start:
Date facility will be in service to provice medical service:
PERSONAL PROPERTY
Personal property is machinery and equipment which is readily movable. It is generally unattached in any way to a building or structure and
is also not connected to other real property machinery and equipment. Attach additional pages if necessary.
Serial
Purchase
Purchase
Date
Owned / Leased
Date
Make / Model / Type
Number
Date
Price
Installed
In Use
(check one)
REAL PROPERTY MACHINERY AND EQUIPMENT
Real property machinery and equipment is machinery and equipment that is not easily movable. Machinery and equipment means any
property used in the business activity or process except land, buildings, and structures. It does not include furniture, commercial fixtures, or
structural components of a building such as standard wiring, plumbing, heating or cooling systems. Attach additional pages if necessary.
Serial
Purchase
Purchase
Date
Owned / Leased
Date
Make / Model / Type
Number
Date
Price
Installed
In Use
(check one)
BUILDINGS AND STRUCTURES
New building or structure and addition to or modification of an existing building or structure:
(check one)
Own
Lease
Both—Describe:
LATE FEE
If this form is filed after April 1, the late filing fee must accompany the form. The late filing fee is one-tenth of one percent of the real market
value, or $200.00, whichever is greater. A late fee is attached:
Yes
No
DECLARATION
I declare under the penalties for false swearing [ORS 305.990(4)] that I have examined this document (including any accompanying
attachments and statements) and to the best of my knowledge, it is true, correct, and complete.
Name (please print or type)
Title
Signature
Date
X
150-310-089 (9-01) Web
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial