Agenda - 02-03-1998 - 8e - Laserfiche WebLink

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11tret AV-10 YEAR J ICJ 4 APPLICATION FOR PROPERTY TAX EXEMPTION ` r County ct, Town or City Q \ • `� owner y(n5�':�lti\e¢ ,r '-D av��u t—e,� y-�� v<< Address 2-1 C, ^(Street at Roue) ` ( orn) \ (St ) /(Zip Code) 24 t.ocatton of Property INSTRUCTIONS Under the provisions or 0. S. I05-211.1 every owner of property claiming exemption or exclusion from property taxes must demenstn property me* that the proper meets the statutory mQuirements for exemption or classification, Claims for exemption or exelu- sien muat be filed with the tax supervisor of the county in which the properry is located. (see ravers. side) Claims for exemp- tion should include all land and imptoveseents and personal propenT'simated theteoe and complete information retarding its use. The undersigned owner or authorized representative hereby petitions for exemption of the following described prop- erty: 2. Give complete description of property: Land: fir 1A Improvements: Personal Property: I. List and explain the purposes for which the property is used: Land: Improvements: � IV n Personal Property: r a 4. If Inv organization other than the owner uses t*_Nproperty, give the name of the organization, full particulars regarding its use of the property and the amount of any income received for such use. 5. Give your estimate of the true value 6. List the insurance value of the property: in money of the property:. r/� /VIt xxxxxxxzxxxxxxxzxzxxzzxzxzxxxxxxzzzxxz Land Improvements Personal Property: 101 000 ZfS 0 0O 6. Upon what uses or purposes do you base this claim for xemption? rCharitable ( ); Relig'ous ( ); / Educational ( ): Literary ( ); Scientific ( ); Othera )� �� 7, Give the specific statutory authority upon which this property is claimed as exempt: :�;: S (Full texts of all exemption and classification statutes-are available at the office of the county tax supervisor.) AFFIRMATION Under pmelties prescribed by law, I hereby afntm that to the best rny knowledge and belief, the statements and information in this application are we and correct, and are made for the purpose of exam tie the prope1rry bereie eseribad from taxation. ature of owner or "thnf6d mpresentatrve isle Telephone \o.