Application For Institutions Of Purely Public Charity Property Tax Exemption
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3CR-IPPC
For Office Use Only
Approved
Name of organization _____________________________Assessment year ____________
Denied
Assessor’s signature ______________________________Date _______________________
Institution of Purely Public Charity
Property Tax Exemption Application
Please read the instructions before you complete this form. If you are not applying for exemption as an institution of purely
public charity, fill out Form CR-PTE, Application for Property Tax Exemption.
To be completed by all applicants
Name of Organization
Date Property Acquired by Organization
Representative or Owner Name
Title
Date of Application
Mailing Address of Organization
City
State
Zip Code
County
Are you claiming exemption as an institution of purely public charity?
Yes
No
If no, file Form CR-PTE, Application for Property Tax Exemption.
Is the above organization exempt from federal income tax under section 501(c)(3)?
Yes
No
Please include your Articles of Incorporation and your Federal Form 990 with this application. (See instructions.)
Property Address of Property for Which Exemption is Sought
City
State
Zip Code
County
Legal Description of Property (attach additional sheets if necessary)
Parcel ID Number
Principal Use of the Property
Additional Uses of the Property (give percentage of use):
Are these uses directly related to the mission of the organization?
Yes
No
How is the property used to acheive or further the organization’s mission?
Is the purpose to be helpful to others without expectation of material reward?
Yes
No
List donations, gifts, or government grants received last year:
Donations:
Gifts (Monetary Value):
Government Grants:
If you do not receive any donations, gifts, or government grants, please describe how this organization is supported.
Continued
(Rev. 07/14)
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