AFFIDAVIT FOR TAX EXEMPT USE
I,
, being duly sworn under oath, understand that the
penalty of perjury can be imposed for falsified statements, and do hereby testify as follows:
1) I am the
_____________________________________________________________
(Title)
for _________________________________________________________________.
(Organization)
2) The real property(ies) identified as Permanent Index Number(s)
_______________________________
______________________________
_______________________________
______________________________
is/are being used solely by the
_____________________________________________________________________
(Organization)
for tax exempt purposes.
3) That the activity/usage of the property(ies) is as follows: ______________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(attach additional page if needed)
Signed: ________________________________________
Subscribed and sworn to before me
this
day of
20 .
_______________________________________________
Notary Public
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