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Fenn AV-10
<br />(Rev. 6-97) YE/iR `•~~:(~'=~ _
<br />APPLIUA71Ui~ t=Un PHUPEfi7Y 7'1i:~ i)(~R~IPTIUid
<br />II :
<br />1 County % ~ Ce e r%. ~_ Town or City ~ ~-i,t rT.l l~
<br />Address_~1::~~. L,, wc•~r•",~ ~'7T_5-.:;ti Iii (.1; •:,t:. 1-~`\L._._~:.~.z._...__~ `~ 7 "1. ~(,
<br />(SUOet or Routoj (Town) (Stara) (Zip COtloj
<br />Under Iha provisions of G. 5,. i 05-282.1 Query ovmer of property claiming exomption or axciusion h•om property taxes must demonstmto that the properly
<br />meets the statutory requirements for oxernptlon or ciassilica6on. Claims ter exomption or exclusion must be tiled with the Assessor of the county in
<br />which the property is located. (see reverse side) Claims (or exemption should Induda all land and improvements and personal property sim~led.~I,•eiez7~
<br />and complete inlormaGon regarding its use. S
<br />The undets(gned owner or authorized representative hereby petitions for exemption o1 the following described property:
<br />2. Givecomp(e? description o(praperty:_~„2~,~~1? ~ ~C~v~~i%- -_ ~~_ __ __
<br />
<br />Personal Properiy:~
<br />3. List and explain the
<br />Improvements:_ 7:
<br />Personal Property:
<br />for which the property is used:
<br />
<br />4, If any organization other Phan the owner uses the property, give the name of the organization, full particulars regarding its use of the
<br />property and the amount of any income received for such use, _.____S, ~~.._.___~_ ~._. ~ _.,..~_~.,.,
<br />5. Give your estimate of the true value in money of the property:
<br />land: -~~,_l,>_~\~'(_ ~"-'-- ~_.,,____.-~__ ..__ .._. __.,_.__.__.~_.______.__._..
<br />Improvements: ~t. ~- .~. ~R',,~`__"-_. __~..__.__~_ ___.__..~.v___________.._._...__-_.___._ __._._,
<br />,. `, :: _
<br />Personal Pro er :__' c ~•~L% `'~`~
<br />p ty t._.~...~.__.__,.._.~_.._____._._ ,__._...__ ---. _.,_.-.._~__.____~_..
<br />6. Upon what uses or purposes do you base this claim for exemption? Charitable ( j; Religious ( ); Educational ( );
<br />Literary ( ); Scientific ( ); Other_~-~ ~?_~;•~,~. - n•n r•4rlc_~_,y4,n„-.,.(y~„ '~?. •l,_,,.;-~,,,r,~+v-.i.: c~;..; ;c~~.•;<
<br />T. Give the specific statutory authority upon which Utis property is claimed as exempt: A ~ ~:(, °~ ,~ C-' `'~?_' ~~~ •- ' _'s ~ -____.'
<br />(Full texts of all exemption and classificatiorz statutes are available ai fire o~te of the corrrrly ~4s.ressor.J
<br />AFFIRMA7IQN ^
<br />lJnder penalties prescribed by law, I hereby affirm 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 exempting the property herein described Irom taxation.
<br />~~~
<br />- 1;H~------_
<br />Slgnalure.ol
<br />representative
<br />_ ~
<br />hPPROVED f-~~ ~. ~ ic7.t^, ,, ::, ;-!~h~__^.~.t\.1,1 ,~~~~:,: ?? /. ='!._
<br />YES ~ id0 Tlllo Telephone Die
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