Application for Property Tax Exemption

Application for Property Tax Exemption
This application must be filed with the assessor every year by February 1 of the year for which the exemption is claimed.
Property Number:
Property Owner:
Property Address:
Legal Description
Exemption Claimed Pursuant to One of the Following Sections of the North Dakota Century Code (N.D.C.C.):

1. N.D.C.C. § 57-02-08(9), property used exclusively for public worship or property belonging to a religious organization and used for religious purposes: Church Parsonage Other (attach explanation)
2. N.D.C.C. § 57-02-08(8), property owned by an institution of public charity and used for the charitable purposes for which it was organized: Public Hospital(1) Nursing Home(1) Other (attach explanation)(1)
3. N.D.C.C. § 57-02-08(11), property owned by nonprofit lodges, clubs, etc. and used for their meetings and ceremonies: a. If licensed to sell alcoholic beverages, describe each area of the building where these beverages are sold or consumed. b. If food is sold, describe each area of the building where the food is sold or consumed.
4. N.D.C.C. § 57-02-08(20), buildings owned and occupied as a homestead by one of the following: a. Paraplegic Disabled Veteran or Veteran awarded specially adapted housing or unremarried surviving spouse.(2)(4)(5)(6) b. Permanently and Totally Disabled Person Confined to a Wheelchair or unremarried surviving spouse.(2)
5. N.D.C.C. § 57-02-08(22), buildings owned by a blind person and/or spouse and occupied as a home by the blind person.(2)
6. N.D.C.C. § 57-02-08(26), buildings owned and occupied as a homestead by a paraplegic disabled person or unremarried surviving spouse.(2)(3)
7. N.D.C.C. § 57-02-08(31), group homes owned by nonprofit corporations.
8. N.D.C.C. § 57-55-10, mobile home is exempt or the provisions of N.D.C.C. Ch. 57-55 apply.
9. N.D.C.C. § 57-02-08(15)(a)(3)(a)(2), farm storage structure located on platted land within city limits.
10. N.D.C.C. § _ Subsection _.

For what purpose(s) was the property used during the 12-month period prior to the year for which this exemption is claimed? (Note: Be specific.
If there were several types of use, indicate such usages by square foot areas of the building and floor location. If additional space is needed, attach another sheet.) Is any income derived from the use of any portion of this property by other individuals or groups, whether considered as rent or reimbursement for expenses or services rendered? Yes No If yes, give details:
(1) Provide a current copy of organizational documents supporting claim (e.g., articles of incorporation and by-laws, etc.) if claiming exemption for first time or upon request.
(2) Provide an affidavit or physician's certificate if claiming exemption for the first time.
(3) Provide an annual statement that previous year's income did not exceed the amount provided in N.D.C.C. § 57-02-08.1.
(4) Provide a copy of the DD Form 214 showing veteran's honorable discharge from active military service if claiming exemption for the first time.
(5) Provide evidence from the Department of Veterans Affairs showing award of specially adapted housing if claiming exemption for this status for the first time.
(6) A person shall furnish to the assessor or other assessment officials when requested to do so any information that is believed will support the claim for exemption for a subsequent year.
I (We) make application for real property tax exemption for the year __ on the property described above and, in compliance with North Dakota Century Code § 57-02-14.1, certify the information is accurate to the best of my (our) knowledge and belief.
Note: N.D.C.C. § 12.1-11-02 provides that making a false statement in a governmental matter is punishable as a Class A misdemeanor.
Market value of property claimed exempt: $
Date property was acquired:
Applicant Date
Assessor or Director of Tax Equalization Date
Application is: Approved Disapproved