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9. Declaration of owner's religious mission and purposes:

Provide a declaration of your religious mission and purposes, either by stating it here, or by attaching a copy. This should be a written document

detailing the ministries commissioned by your organization for the purpose of propagating its faith or carrying on humanitarian work. This is NOT the

same as an explanation of the uses of the property. YOUR APPLICATION WILL NOT BE ACCEPTED WITHOUT THIS WRITTEN DECLARATION.

_________________________________________________________________________________________________

NOTE: Questions 10, 11, and 12 ask you to designate each use of the property as either in furtherance of your organization's religious

mission (10); NOT part of your mission, but qualifying for exemption as used for school, strictly charitable, or religious purposes (11); or not

claimed as an exempt use (12). Each use should be listed under only one category and the uses listed in 10, 11, and 12 combined should

include ALL uses of the property. If the property has large areas which have no buildings or improvements, be sure to describe the uses of

these areas as well.

10. Uses in furtherance of owner's religious mission:

List all uses of this particular property during the past twelve months (or that portion of the past twelve months that you've owned the property), which

were considered to be in furtherance of the organization's religious mission or purposes, including uses by the owner. Please be sure to list only actual,

not potential, uses. This list must contain both the name of each user and a brief description of the usage of this particular property. Use attachments

as needed. (NOTE: If property is NOT used, exemption CANNOT be granted. Property must either have sufficient actual physical use, or must have

at least one actual physical use per twelve month period and sufficient continuing indicators of intent. “Indicators of intent” are the owner’s off-site

activities which establish its specific intent to further use the subject property for religious purposes. See Rules II.B.11 and II.B.12 for details.)

NAME OF USER

| BRIEF DESCRIPTION OF USAGE

______________________________|___________________________________________________________________

11. Uses for non-profit religious, charitable, or school purposes NOT in furtherance of owner's religious mission:

List all uses of this particular property, during the past twelve months (or that portion of the past twelve months that you've owned the property), which

you believe to be for non-profit religious purposes, non-profit school purposes or for non-profit, strictly charitable purposes, but not claimed as part of

the owner's religious mission. This list must contain both the name of each user and a brief description of the usage. If there were no uses under this

category, please write `NONE' in this section. Use attachments as needed.

NAME OF USER

| BRIEF DESCRIPTION OF USAGE

______________________________|___________________________________________________________________

12. Uses for non-exempt purposes:

List all non-qualifying uses of this particular property during the past twelve months (or that portion of the past twelve months that you've owned the

property). This list must include:

A. All uses which were not part of the owner's religious mission/purposes, and uses where the user/usage didn't qualify as using the property for

religious, school, or strictly charitable purposes; and

B. All uses which were for for-profit purposes, or by for-profit users.

This list should contain both the name of each user and a brief description of the usage. If there were no uses under this category, please write `NONE'

in this section. Use attachments as needed.

NAME OF USER

| BRIEF DESCRIPTION OF USAGE

______________________________|___________________________________________________________________

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