ࡱ> %` 7bjbj"x"x T@@%]~~~~$ooooq,uL||||rDG$ОҞҞҞҞҞҞ$h"%l""~~||"~||О"О:,l^T|u Gy3Qo2( |T՟0&.Z<TT(k r}\لIkkkkkk""""PVDV~~~~~~ Application for Real Property Tax Exemption and RemissionDTE 23 Rev. 4/05  FORMTEXT  FORMTEXT       Date received by county auditorDate received by DTEOffice Use Only County application number DTE application number General Instructions + Submit three copies of this application to the auditor's office in the county where the property is located. (Make a copy for your records.) Applications should not be filed until the year following acquisition of the property. The final deadline for filing with the county auditor is Dec. 31 of the year for which exemption is sought. If you need assistance in completing this form, contact your county auditor.+ Both the County Auditor's Finding (page 3) and the treasurer's certificate (page 4) of this application must be completed. Ask your county auditor for the procedure to follow to obtain the Treasurer's Certificate. When presented with this application, the county treasurer should promptly complete the certificate and return the application to you so it may be filed with the county auditor. The county treasurer should make certain the treasurers certificate is complete and accurately reflects the payment status of taxes, special assessments penalties, and interest, by tax year. Obtain a copy of the property record card from the county auditor and enclose it with this application. It is the applicant's responsibility to make sure the information supplied by the county auditor and county treasurer is complete and accurate.+ Answer all questions on the form. If you need more room for any question, use additional sheets of paper to explain details. Please indicate which question each additional sheet is answering. This application must be signed by the property owner or the property owners representative. Please Type or Print Clearly  Application is hereby made to have the following property removed from the tax list and duplicate and placed on the tax exempt list for the current tax year, and to have the taxes and penalties thereon remitted for these preceding tax years:  FORMTEXT       Applicant Name: FORMTEXT      Name Notices concerning this application should be sent to: FORMTEXT      Name (if different from applicant) FORMTEXT      Address FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      CityStateZIPTelephone number 1.Parcel number(s) (if more than four, continue on an attached sheet). All parcels must be in the same school district.a) FORMTEXT      b) FORMTEXT      c) FORMTEXT      d) FORMTEXT       2.School district where located FORMTEXT      3.Total size of parcel(s) FORMCHECKBOX Less than ONE acre FORMCHECKBOX One acre or MORENumber of acres FORMTEXT      4.Street address or location of property FORMTEXT       5.a)Title to this property is in the name of FORMTEXT      b)Address of owner FORMTEXT      6.If title holder is different from the applicant, please explain FORMTEXT      7.Title holder is: FORMCHECKBOX A nonprofit corporation FORMCHECKBOX An unincorporated association/organization(check one) FORMCHECKBOX An individual FORMCHECKBOX Other  FORMTEXT      8.Exact date title was acquired FORMTEXT      9.Title was acquired from FORMTEXT      Please attach copy of the deed.10.Does the applicant have a lease or land contract for this property? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please attach a copy.11.Amount paid by title holder for the property FORMTEXT      12.Exact date the exempt use began FORMTEXT      13.Under what section(s) of the Ohio Revised Code (R.C.) is exemption sought?R.C.  FORMTEXT      R.C. FORMTEXT      R.C. FORMTEXT      14.How is this property being used? Do not give conclusions such as charitable purpose, public worship, or public purpose. Be specific about what is being done on the property and who uses it. If the property is not currently being used, but there is an intent to use it later for an exempt purpose, describe the intended use and the date set for the intended use. FORMTEXT      15.During the years in question, was any part of this property (check one):a)Leased or rented to anyone else? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please attach copy of lease agreement.b)Used for the operation of any business? FORMCHECKBOX Yes FORMCHECKBOX Noc)Used for agricultural purposes? FORMCHECKBOX Yes FORMCHECKBOX Nod)Used to produce any income other than donations? FORMCHECKBOX Yes FORMCHECKBOX NoNote: If the answer to any part of question 15 is yes, enclose all details on a separate sheet of paper. If money is received, submit profit and loss statements, income and expense data, balance sheets, or any other financial statements.16.Is anyone living or residing on any part of this property? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, answer the following:a)The persons name and position FORMTEXT      b)The resident s duties (if any) in connection with this property FORMTEXT      c)The rent paid or other financial arrangements FORMTEXT      17.Is anyone using this property other than the applicant? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, please enclose a complete, detailed explanation.18.Does the applicant own property in this county which is already exempt from taxation? FORMCHECKBOX Yes FORMCHECKBOX No19.Property used for charitable purposes.Please provide articles of incorporation, constitution or by-laws, IRS determination letter and any other similar relevant information.20.Property used for senior citizens residences.If the purpose of the property is to provide a place of residence for senior citizens, submit all information required by R.C. section 5701.13.The Ohio Department of Taxation may set a hearing on this application. If there is a hearing, the applicant must present a witness who can accurately describe the use of the property in question. A notice of at least 10 days will be given to the applicant concerning the time and place of any hearing. 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h.?hZCJOJQJ^JaJhZCJOJQJ^JaJhZ5CJOJQJ^JaJ!h.?hZB*OJQJ^Jph/jhfFB*OJQJU^JmHnHphu0jOThfFhfFB*OJQJU^JphhfFB*OJQJ^Jph$jhfFB*OJQJU^Jph"/$/4/6/#ikd[U$$Ifl    *+ t0    644 la$IfikdT$$Ifl    *+ t0    644 laP/Z/\/^/`/t/v/x/|/~///////////////////ԹԹxjYjYjYxԹ h.?hZCJOJQJ^JaJhZCJOJQJ^JaJhZ5CJOJQJ^JaJ0jVh.?hZB*OJQJU^Jph0jaVh.?hZB*OJQJU^JphhZB*OJQJ^Jphh.?hZOJQJ^J$jhZB*OJQJU^Jph/jhZB*OJQJU^JmHnHphu6/^///////iaaa$Ifkd5W$$Ifl    :F *  t0    6    44 la$If/// oii$Ifkd-X$$Ifl    F *  t0    6    44 la///////0         > @ H    ԼԯԡԼԯwiXiXwK: hhZCJ OJQJ^JaJ hGAhZOJQJ^J h.?hZCJOJQJ^JaJhZCJOJQJ^JaJhZ5CJOJQJ^JaJ0jYh`hZB*OJQJU^JphUhZB*OJQJ^Jphh.?hZOJQJ^J/jhZB*OJQJU^JmHnHphu$jhZB*OJQJU^Jph0jYh`hZB*OJQJU^JphEXT      Telephone numberDate County Auditor s FindingLandBuildingTotalTaxable Value in Year of Application FORMTEXT     (Tax Year) FORMTEXT       FORMTEXT       FORMTEXT      Taxable Value in Prior Year FORMTEXT     (Tax Year) FORMTEXT       FORMTEXT       FORMTEXT      This application covers property that is (check all that apply): FORMCHECKBOX Currently exempt* FORMCHECKBOX New construction on previously FORMCHECKBOX Currently on CAUV FORMCHECKBOX Previously exemptexempted parcel FORMCHECKBOX Previously on CAUVAuditor s Recommendation: FORMCHECKBOX Grant FORMCHECKBOX Partial Grant FORMCHECKBOX Deny FORMCHECKBOX NoneComments: FORMTEXT        FORMTEXT      County auditor (signature)DateForward two copies of the completed application to the Ohio Department of Taxation, Equalization Division, P.O. Box 530, Columbus, OH 43216-0530. *If the property or any portion of the property is currently exempt, please indicate the type of exemption, the portion of property exempted, and the tax years to which the current exemption applies. Treasurer s CertificateIf the Treasurer s Certificate is not properly filled out and signed, the tax commissioner will have no jurisdiction to act on the application, and it will be subject to dismissal.(Notice to treasurer: The first paragraph of this certificate must always be complete.)I hereby certify that all taxes, special assessments, penalties and interest levied and assessed against the above described property have been paid in full to and including the tax year FORMTEXT     . The most recent yearfor which taxes and special assessments have been charged is tax year FORMTEXT     . I further certify that the only unpaid taxes, special assessments, penalties and interest which have beencharged against this property are as follows:Parcel NumberTax YearTaxes (including penalties and interest)Special Assessments (including penalties and interest) FORMTEXT       FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      FORMTEXT       FORMTEXT      If additional years are unpaid, please list on an attached sheet.Have tax certificates been sold under R.C. 5721.32 or 5721.33 for any of the property subject to this application? FORMCHECKBOX Yes FORMCHECKBOX NoAre any unpaid taxes listed on this certificate subject to a valid delinquent tax contract under R.C. 323.31(A)? 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