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s orm w w_: a <br />c~,<. L'Ol <br />':'~Ai? 3998 <br />- _: 3 <br />AP°LiCATIOiV FGR ?ROPERTY TAX EX.=,7iPTION <br />County Orange Town or City Carr~oro <br />owRe; UCC Living Centers T~')r^.nrnnral-.aA <br />Address 100 Leonard Avenue N ~trt-nn ~~ 28658 <br />(Stract or Route) (To+nt) (State) (Zip Code) <br />4 .. - io3 C.t,~•i ~,t ~h-~-~ <br />1. <br />Locstton of Property <br />9 <br />t <br />~~~t:,~.~ . ~Gt~.clt .,~ <br />INSTRUCTi0P1S <br />Under tha proriaiona of G. S. 103-2aZ1 ersry ortt er o! ptogerry elaimint azneptioa er aseln aion (tom ptopert~ uzsa moat <br />dsmewatra is that the Droosrry mesa the aumwry requuiremeats [or azemotion or elsaaific:tiaa. Gaims fer eztmtptioa or azclu- <br />aion must Js Clod with th• tea sunerrisot of the wunry in ••hieh tha prvpsrty is located. (ase rerene aids) Ciainu for e:emta. <br />don should iacluda ell land and imoror®enu and personal propsrtp situated. dtsrtwa and txnaplen ialormauoa nisrdiai its nos. <br />Theundersignedowner of authorized representative hereby pc titions Cot exemption of the following descibed prop- <br />erty: <br />2. Give complete description of property: <br />Land• ~ 914 At~rPa <br />meats: <br />Personal Property: <br />3. List and explain the purposes for which the property is used: <br />Lana: Low income elderly housing <br />Improvcmenu: Si3I[le aS abOVe <br />Persona! Property <br />+. If any organization ocher than the owner uses the property, give the name of the or;anization. Cull particulars <br />regarding its use of the~~roperty and the amount of any ineor..e rcccivt:d for such use. <br />S. Give amour estimate of the true value <br />in money of thtr ro err <br />Land ~ 213 r'~IOg.(~0 <br />Improvements ~R]US s 31 ? _ 00 <br />Personal Property: 140.631.00 <br />b. List the insurance value of the property: <br />SXXXXXXXXXXXX:.X XXXXXXXX XX7cX :XZSXXXXXXX <br />b. Upon what uses or purposes do ;rou base this claim for exemption? Charitable Ql:); Religious ( ); <br />Educational ( ); Literary ( ): Scientific ( ); Cther <br />7. Give the specific starstory authority upon which this properi•~ is claimed as cXempt: G.S.~~. 105-278.5 <br />(a) (8) and 24 C F R & 202 et gam, <br />(Foil texts of all eze:eption and classification statrctes are availccle at the of[ice of the munry tax supervisar_) <br />AFFIR.1lATlCN <br />• IInder pstrateisa prescribed b7 las, t hsrstr/ afArm that la tha boat of toy taorlsdt• and belief, the atatseaeaes and infotmatien in this <br />application ors one and wrrect. sad ors made for the parpoas of •saaoptiat tlaa 9toDerty herein deatYibsd f acioa. <br />'JLlne '0 . 19 _9S_ ,V/(•'//1---- i~l~~ <br />- Sisaature o! orna or aathorizcd represtmunre <br />.~ <br />Co-Chairman s60-3334 <br />Title Telephone ,l'a. <br />