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Auk 27 0? 12.59p Orange Caunt~ Tax <br />Form AV-111 YEAR 2-~ ~ <br />Web APPLICATION FOR PROPERTY TAX EXEMPTION <br />10-Q2 <br />(~rG-~~-+~- Tawn or City ~'~rn ~~ <br />County - ~ _ <br />Owner ._._~_j' "'-- -~-Ir <br />Address `.Jy~ t or Route) - <br />lag D SIG 7i1C7 ~ ~j <br />~- (State) tup Vwc) <br />p.l <br />O <br />1. <br />Location of Properly INSTRUCTIONS <br />e rovisions of G. S. 105-282.1 every owner of properly claiming exemption or exclusion from property taxes must demonstrate that the proPe Y <br />Under th p ert situated thereon <br />tuto requirements for exemption or classitication• tiotn should include all land and improvements land pierstonaApropso~of the county m <br />meets the ste rY <br />which the property is located. (see reverse side) Claims for exemp <br />and complete information regarding Its use. <br />t'v etitions for exemption of the following described property: <br />The undersigned owner er authorized represents t e hereby p dC~ ~ ~ ~ <br />Swi rvtm~,+~ <br />2. Give complete description of property: <br />Improvemcnts: <br />Personal <br />3. List and explain the purposes for which the property is used: t <br />Land:----,--. ~ ~ _ .,-,,, . ~ 1 . ,<,.. <br /> <br />1 <br />Improvements: <br />Personal Property: `~-"~-''" <br />D.J~i <br />4. If any organization other than the owner uses the property, give the nab the organization, full particulars regarding its use of the <br />property and the amount of any income received for such use. <br />b, Give your estimate of the true value in money of the ropei Y= ~ v <br />Land: ~ t, Nn •1 ~ ~~ <br />Improvements: ----------- ~O v~..~ <br />Personal Property: <br />6. Upon what uses or purposes do you base this claim f~~ o~~~ Pt~~~ <br />)• Scientific ( ); Ocher <br />Charitable ( ); Religious ( ); Educational ( ); <br />Literary ( tl..r ~ r ~.~--~ ~.. , ..__• - <br />7. Give the specific statutory authority upon which this property is claimed as e~ pt: ~~~~ ~~ Lid . <br />4 .F '~ 2.. .e.~v ~'" ~-~1'~t,t.s <br />(t%ull texts of nil exemption and classification statutes a1~e available at the office of the cor~nty Assessor) <br />AFFIRMATION <br />Under penalties prescribed by law, 1 hereby aer u~ose f xbeestt,f mhe Pr~P ~y herein describedtfram taxatiand information in this <br />appClication are true and-cororrect, an~d~a~re]made for -h p P <br />lO ~ry1~-~-~ ` 20 -=--t-- dig slurs of owner or authorized representative <br />_. ~e~it dY C~yt,Yyttt,,,w~h.l V~l~ ~ a ~a • 4~~1 ~ [~4~ 0 <br />~~~V IGIG(.+~' Nn <br />APPROVEt] ~ YES ~ NO Title <br />