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YEAR <br />APPLICATION FOR PROPERTY TAX EXE1AETPON <br />County irl _Town or City <br />Owner fo <br />Address — <br />(Street or Root,) (Town) (state) (Zip Code) <br />l -oea tton or Properly �-�}^� � - �,r, �/r <br />L`IS- T(RUU'CrIOfVN.S <br />Under the provisions or G. S. 105 -111.1 every owner of property claiming exemption or exclusion from properry taxes moat <br />d nnonatn to that the properry —ts the aututory reduiremeotr for oaem0 tion or elattsir�cation. Claims for exemption or exclu- <br />sion must be filed with the tax supervisor of the rn unty in whith tho property is located. (Joe reverse aid.) Claims for eremp- <br />tion should include all lend and improv .ts and personal prnp.rty situated thereon -A complete int— salon rex.tdint iU use. <br />The undcrsigncdowncr or authorized representative bctcby petitions for cxcmption of the following described prop - <br />crty: <br />Z. Give complete des ` ip ton of property: — <br />Land: �-/11 q <br />Improvements <br />Personal Property: — <br />3. List and explain the purposes (or which the property is used: <br />Land: V <br />jmprovcmrnis: <br />Personal Property: <br />-t. If any organization other than the owner uses the property, give the name of the organization, full particulars <br />regarding its st�c of the property and the amount r,( any income received for such use. -- <br />5. 'Give your estimate of the true value 6. List the insurance value of the property: <br />in money of a property: <br />Land -�� uxzxzzzxzxxzuzxxxzzzxzzzzzzxzzzxzzzz <br />lm roycmcnts <br />D � <br />Personal Property: �5--- <br />6. Upon what uses or purposes do you base this claim for exemption? Charitable ( ); Religious <br />Educational Nr.�; Literary ( ): Scientific ( ); Other <br />7. Give the specific statutory authority u on which this property is clai ed as exempt: <br />3 <br />(Full texts of all exernprion and classification statutes arc available at the office of the county far sup tsar. <br />AFF1RMATION <br />Under penalties prescribed by law, I hereby affirm that to the best of mr hnowledje and belief, the statements and Information in this . <br />application are true and correct, and are made for the purpoaa of .xamptina the m eery herein des ib. from ti... <br />19� <br />Sianat c of owner or sexthonxed rep cntauve <br />_a <br />{� ct�j <br />Title Telephone \o. <br />ate Zp <br />i . , , • i� <br />