Form Rp-420-A/b-Use - Application For Real Property Tax Exemption For Nonprofit Organizations Ii - Property Use Page 2
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4RP-420-a/b-Use (9/08)
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9. Does any person or organization have a reversionary interest in this property?
Yes
No
a. If yes, indicate name and address of such person and state terms of right of reverter:
10. Describe, in detail, use or uses of the property:
IF THE ORGANIZATION SEEKING EXEMPTION HAS INDICATED ONE OF ITS CORPORATE
PURPOSES IS HOSPITAL IN QUESTION 2a. ON FORM RP-420-a-Org, ANSWER QUESTION 11.
IF NOT SKIP TO 12.
11. Are the premises or any portion thereof leased or otherwise occupied as professional offices?
Yes
No
If yes, answer a through c.
a. The professional offices are leased or otherwise occupied by: (1)
members of the staff, e.g. doctors
(2)
professionals not on the staff of the hospital
(3)
a combination of 1 and 2
b.
If leased to members of the staff, are the offices used:
(1)
solely for hospital related matters
(2)
for the private practice of the staff members
(3)
a combination of 1 and 2
c.
If not used solely for direct-hospital related purposes, what percentage of time and space are the offices
used for direct hospital-related purposes, and what percentage of time and space are they used for private
practice of the staff?
12. Is the property or any portion thereof regularly occupied by persons or organizations other than applicant?
Yes
No
If yes, answer a through d.
a.
Name of occupant(s)
b.
Use by occupant(s) (also indicate specific portion of property so occupied):
c.
Term(s) of occupancy (e.g. one-year lease, month-to-month tenancy):
d.
Amount of rental paid by occupant(s)
13. Is the property or any portion thereof occasionally used by persons or organizations other than the applicant?
Yes
No
If yes, state use and indicate specific portion of property used, frequency of use and fee charged or
contributions received for use:
14. Are there any buildings or other improvements on the property?
Yes
No
If yes, skip questions a through e. If no, answer a-e and skip questions 15-16.
a.
Use or uses of property if not described in question 10.
b.
Are building or other improvements contemplated on this unimproved land?
Yes
No
If yes, give full details including proposed use(s):
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