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F.— AV-10 <br />(Rev. ;-rol YEAR Igo 6 <br />APPLICATION FOR PROPERTY TAX EXEMPTION <br />County Town or City 6hg <br />Owner (=-�cQ A) ee.11..� t ?� nt2*sC. W S C2 <br />Address <br />/ L (Str.et or R e) (Zorn) . j(State) (Zip code) <br />t.oeauon *(Property <br />)__" <br />INSTRUCTIONS <br />Under the provisions of C. S. 101 -222.1 every owner of property claiming exemption or *:elusion from property taxes must <br />demonstrate that the property meets the statutory requirements for exemption or claasificatios. Claims for exemption or exclu- <br />sion must ba filed with the tax supervisor of the county in which the property is located. (ace reverse side) Claims for exemo. <br />tion should include all land and improvements and personal property situated thereon and complete information regarding its use. <br />The undersigned owner or authorized representative hereby petitions for exemption of the following described prop- <br />erty: <br />2. Give cor(tplete description o property: / r� -6 <br />CIE Land. h <br />Improvements: 2 ✓cf C34n 6W7e <br />Personal Property: <br />3. List and explain the purposes ffo�or //whit t property is used, p <br />Land: ' 5 / /D� �Ef /G�'CSJ St /tP —( _C V5 ' <br />Y' ' Q <br />I ptovements: Q <br />Personal Property: �] d n `Z­� <br />4. if any organization other than the owner uses the property, give the name of the or ;anizatjpn, full particulars <br />re ardin useAf /t a ro rt nd the arno�t of an into c received for suc use. A*/i /1/+dt1 <br />g , J'2�e¢J �P 4r),X. C c-Y� /fLJdPe�ee_� J RG�✓» �, �d! <br />5. Give your estimate of the true value <br />in money of property: <br />Land _�7. 44,0 U _ <br />Improvements d <br />Personal Property: <br />6. List the insurance value of the property: <br />xxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxx <br />6. Upon what uses or purposes do you base this claim for exemption? Charitable (Vvx: Religious ( ); <br />Educational ( ): Literary ( ): Scientific ( ): Other <br />7. Give the specific statutory authority upon which this property is claimed as exempt: _Oa-ef %s owcl3 <br />(Fuil texts of all exemption and classification statutes are available at the office of the county tax supervisor.) <br />AFFIMNIATION <br />Under penalties prescribed try law. I hereby afrirm that to the best of my knowledge and belief, the statements and information in this <br />application are true and correct, and are made for the purpose of easawting thZp he rein described from Ovation. <br />Signature of owner or autho Zed reprti save <br />�/ . .a <br />(�f�LT7Ge ) -e(7r . <br />Titic Telephone So. <br />