Agenda - 12-15-1981 - Laserfiche WebLink

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©.1257 Form AV-lo y�AR (Rev.4-74) APPLICATION FOR PROPERTY TAX EXEMPTION �ty� ) 2-or�,y4. 14 C- County 0-/...4-4/0 P Town or City 1 f/ S jj 2 t )71///.> 3' �l c1" GA vYch. Owner d / / a Address / S (Street or Route) It (Town) oe (State) (Zip Code) ... _- 1.. - e/✓ c , Location of Property INSTRUCTIONS Under the provisions or G•S, 105.202.1 every owner of property claiming exemption or exclusion from property tones must demonstrate that the property meets the statutory requirements for exemption or classification.. Claims for exemption or exclu- sion must be filed with the tax supervisor of the county in which the property is located. (see reverse side) Claims for exemp- tion should include all land and Improvements and personal property situated thereon and complete information regarding 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: , Improvements: . Personal Property: 3. List and explain the purposes for which the property is used: f e a. Land: ~ 3 l G i Improvements: • Personal Property: 4. if any organization other than the owner uses the property, 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: xxxxxxxxxxxxxxxxxxxicxxxxxxxxxx xxxxxxxx Land Improvements Personal Property: 6. Upon what uses or purposes do you base this claim for exemption? Charitable ( ); Religious ( ); Educational ( ); Literary ( ); Scientific ( ); Other 7. Give the specific statutory authority upon which this property is claimed as exempt: , (Full texts of all exemption and classification statutes are available at the office'of the county tax supervisor.) AFFIRMATION Under penalties prescribed by law,1 hereby affirm that to the best of ely knowledge end belief,the statements and information in this application are true and correct,and are made for the purpose of exempting the property herein described from taxation. 3c0 19a j 1. 7 !)� ? s/�•q ,c---•-- Sitnaturc at owner or authorized representative U "1 , . .,• 7 3� - 3/23 Title, Tclephon.•Nu.