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<n... l +ol YEAR . <br />APPLICATION FOR PROPERTY TAX EXEMPTION <br />County I A Town or City �4� <br />7 <br />Owner <br />ESL <br />Address <br />Street or Route) (T ) (Stale) _ (Zip Code) <br />Locstton of Property a - ,�J� , u <br />INSTRUCTIONS <br />Under the provi+ionf of G. S. 103 - 212.1 eery owner of proDerry claiming c —ption or exclusion from property taxes mint <br />demonstrate that the property meta the ■-Atutory requirements for exemption or classification. Claims for exemption nr aclu- <br />sion must be riled with the tax supers sor of the county in Which the property is located. (see reverse side) Claims for cxcmp- <br />lion should include all land and imuro —irnts end personal property situated thereon and complete information ragardint it-3 use. <br />The undersigned owner or authorized representatives hereby petitions for exemption of the following described prop- <br />erty: r <br />2. Give complete description of pr Petty: — <br />Land: <br />Improvements: <br />Personal Property: <br />it <br />AM, We <br />a • <br />r <br />r <br />on other than the owner us the property, give a name of the organization, full particulars <br />4. If anyr;jAnizatf <br />regarding its use of the property and the amount of any income received for such use. <br />4 <br />f <br />6. List the insurance value of the property: <br />5. Give your estimate of the trot value <br />in money of tp�o: ^ ^^ zzxz zzzzzxxuxxzzzzzxxzzzzzztxzzzzzz <br />Land <br />itnprot'cncn(s <br />Personal Froperty: - — <br />6. Upon what uses or purposes do you base this claim for exemption? Charitable ( ): Religious <br />Educational ('(Al' Literary ( ): Scientific ( ): Other <br />7. Give the spccific statutory authority upon which this property is claimed as exempt: Q . I <br />(Full texts of all exemption and classi- iication statures are available at the office of the county tax supervisor.) <br />AFFIRMATION <br />Under Drnallics prescribed by law, I hereby affirm that to the beet of my bn'- sate god belie!, Irta atatc en and inf anon in this <br />application are true and correct, and are made far the pumost of ex.emotiot the D h rein described fro soon. _ <br />to-zr� l9 it Signature of o r r suthorited tepres en ea . a <br />Title Telephone So. <br />g� <br />