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,' :©©253- <br /> rr,m,Av-t5 YEAR �19F1 <br /> (Rev. 4-74) <br /> APPLICATION FOR PROPERTY TAX EXEMPTION . <br /> • <br /> County Orange •i'own or City Carrboro � <br /> Owner . Calvary Missionary Baptist Church <br /> 1000 West Main Street Carrboro N.C. 27510 <br /> Address (IewrJ (State) (Zip cede) <br /> (Street ar Route) <br /> • <br /> •• • i.• e ■• •_ I - -- _ <br /> t ne,tirrn of Property ' <br /> • INSTRUCTIONS " <br /> Under the provisions of G. 5, 155-252,1 every owner of property claiming exemption or exclusion from property•taxos must <br /> ecmunstrate that the property meow the statutory requirements for exemption or classification. C141a1 for exemption at excite. <br /> atom ma.rt be filed with the trx rruporvisor or the courtly in which the property Is IocnlmL (see reverse side) Claim•for exemp•. <br /> tioa should include lilt land end improvements and personal property situated thereoa end etnrrylele information regarding Its use_ <br /> h tut undersigned owner or authorized representative hereby petitions for exemption of the following described prop- <br /> erty: <br /> 2, Give complete description of property: <br /> Laid: Tax Map 105, Block Ar Lot 22 •--- <br /> improvements: small frame house . • . • <br /> Personal Property:, none • • <br /> 3. List and explain the purposes for which the property is used: • <br /> Land: ad acent to church on two sides <br /> improvements: • residence for Church caretaker <br /> Personal Property: not a••lieable <br /> 4. If any organization other than the owner uses the property,give the name of the organization, full particulars <br /> regarding its use of the property and the amount of any income received for such use. No other use. <br /> No income derived from this property. Caretaker is allowed to live <br /> in ouse in exe ange or •uties as caretaker. <br /> 5. (live your estimate of the true value 5. List the insurance value of the property: <br /> . -in money of the property: xxxaxxszxxxxs�txxx:cx<xsxxzxxxxzxxxzx cxx <br /> Lana and $12,000.00 ' <br /> improvements ._ $31,604.00 <br /> Personal Property: <br /> (r. L`;ttn what uses or purposes do you base this claim for exemption? Charitable ( ); Religious a);. <br /> Educational ( ); Literary ( ); Scientific( ); Other <br /> 7. (hive the specific statutory authority upon which this property is claimed as exempt: , . '• <br /> Statute 105 72 • <br /> (Full it xts of all exemption and classification statutes are available at the office of the county lax supervisor.) <br /> T— <br /> AFFIRMATION <br /> Unr°.er penaltie r pre:rerihed by law,I hereby affirm that to the beat of my knowledge end belief.the statements and informalien in this <br /> epplacatiqs are true coil correct,and ore mode for the purpose of exempting the property herein described from taxation, <br /> .� _ G ' 19 1•f / -/-- <br /> L'• - Signature of owner/or authorized representative <br /> Rudolph Hardee <br /> Pastor of Calvary Missionary Baptist Chur <br />