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Property Address of Property for Which Exemption is Sought City State Zip Code County Legal Description of Property (attach additional sheets if necessary) Parcel ID Number Principal Use of the Property Additional Uses of the Property (give percentage of use): Are these uses directly related to the mission of the organization? Yes No How is the property used to acheive or further the organization’s mission? Is the purpose to be helpful to others without expectation of material reward? Yes No List donations, gifts, or government grants received last year: Donations: Gifts (Monetary Value): Government Grants: If you do not receive any donations, gifts, or government grants, please describe how this organization is supported. Owner/Property Information Name of Organization Date Property Acquired by Organization Representative or Owner Name Title Date of Application Mailing Address of Organization City State Zip Code County Are you claiming exemption as an institution of purely public charity? Yes No If no, file Form CR-PTE, Application for Property Tax Exemption. Is the above organization exempt from federal income tax under section 501(c)(3)? Yes No Please include your Articles of Incorporation and your Federal Form 990 with this application. (See instructions.) CR-IPPC Institution of Purely Public Charity Property Tax Exemption Application (Rev. 07/21) Please read the instructions before you complete this form. If you are not applying for exemption as an institution of purely public charity, fill out Form CR-PTE, Application for Property Tax Exemption. Property Information To be completed by all applicants Property Uses Continued Charitible Organization Information For Office Use Only Approved Denied Name of organization_ Assessor’s ---PAGE BREAK--- Sign Here Signature of Owner Phone Date Signature of Owner or Authorized Representative By signing below, I certify that the above information is true and correct to the best of my knowledge, and I am the owner of the property or authorized representative of the organization that owns the property for which exemption is being claimed. Do you provide your goods or services for reduced or no cost? Yes No If yes, provide an example: If any of the recipients pay market value for your services, explain: Are any of the organization’s profits (including donations, gifts, or income) distributed to private interests? Yes No Are the beneficiaries of the charity restricted to any group of persons? Yes No If yes, explain the reason for restriction: Upon dissolution, are dividends or assets made available to private interests? Yes No Charitible Organization Information, Cont. ---PAGE BREAK--- Filing for Exemption An institution claiming exemption from property taxes as an institution of purely public charity must file an application for exemption with the as- sessor in the district where the property is located on or before February 1 of the assessment year. This application must be filed every third year. No matter what year the taxpayer initially files for exemption, applications will again be due in 2022, 2025, 2028, etc. You may attach any additional informa- tion you feel is necessary to complete this application, including descriptions of the charitable activities of your orga- nization. If you are filing for property tax exemp- tion as something other than an institu- tion of purely public charity, please inquire at your assessor’s office for the appropriate application form. What Type of Property Qualifies? Minnesota Statute 272.02, subdivision 7 describes the qualifications neces- sary for an institution of purely public charity to be eligible for property tax exemption. The organization must be a 501(c)(3) organization under the Inter- nal Revenue Code and provide a charity to the public. The filing requirements for applications for exemption can be found in Minnesota Statute 272.025. No property will be exempt from taxa- tion under Minnesota Statute 272.02 if the taxpayer claiming the exemption knowingly violates any of the provisions of this section. Required Documentation The following documentation must be included with your application for exemption as a purely public charity. IRS letter granting exempt status as a 501(c)(3) corporation, or an explana- tion of why the letter is not available. Articles of Incorporation for the facility (and the parent corporation if appli- cable). Financial statements or other docu- ments showing the most recent three years of donations for the facility, the total income and total expenses. (Feder- al Form 990 with schedules or certified financial statements show this informa- tion. Sworn statements from the donors may be used to show donations.) Assessor May Request Additional Information Upon written request by the assessor, taxpayers must make available to the assessor all necessary books and records relating to the ownership or use of property which can help verify whether or not the property qualifies for exemp- tion. The assessor may also ask for any information which would clarify ex- planations provided under “Charitable Organization Information.” The assessor will provide you with a reasonable amount of time to provide this additional information. You will be notified in writing of your approval or denial for property tax exemption. If you disagree with the assessor’s deter- mination, you may request an advisory opinion from the Minnesota Depart- ment of Revenue, or you may appeal the assessor’s decision to Minnesota Tax Court. Sale or Purchase of Exempt Property Property which is exempt from prop- erty tax on January 2 and, due to sale or other reason, loses its exemption prior to July 1 of that year, will be placed on the current assessment rolls for that year. Property which is subject to property tax on January 2 that is acquired by a government entity, institution of purely public charity, church or educational institution before July 1 of the year is exempt for that assessment year if the property is to be used for an exempt purpose. Use of Information The information on this form is re- quired by Minnesota Statutes, section 272.02 to properly identify you and de- termine if you qualify for property tax exemption. If you do not provide the required information, your application may be delayed or denied. Your County Assessor may also ask for additional verification of qualifications. Penalties Making false statements on this ap- plication is against the law. Minnesota Statutes, section 609.41 states that any- one giving false information in order to avoid or reduce their tax obligations is subject to a fine of up to $3,000 and/or up to one year in prison. Questions? Contact your County Assessor’s Office for assistance. Form CR-IPPC Instructions