State of Washington
DEPARTMENT OF REVENUE USE ONLY
Department of Revenue
Property Tax Division/Exempt Properties
Registration No:.
PO Box 47471
Olympia WA 98504-7471
Fee
Penalty
Phone: (360) 753-1941
Paid:
Paid:
Refund:
Add
Year Paid:
FILING FEE $35.00
APPLICATION FOR PROPERTY TAX
LATE FILING PENALTY
(See Instructions)
AND LEASEHOLD EXCISE TAX EXEMPTION
As provided in Revised Code of Washington 84.36
1. INDICATE TYPE OF APPLICATION:
2. ENTER WASHINGTON STATE DEPARTMENT OF REVENUE
REGISTRATION NUMBER FOR EXEMPT PROPERTY
(If 1st time applicant, Exempt Prop. Section will assign Reg. No.)
First time filing ($35 fee due)
Addition to existing exemption ($35 fee due)
3. EXEMPTION CLAIMED AS A (Church, School, Hospital, Etc.)
Annual renewal ($8.75 fee due)
4. APPLICANT: (Non-profit organization name)
5. OCCUPANT: (Non-profit organization name)
Mailing Address:
Street Address of Property: (See Inst. page 2, #5)
(Required for on-site visit)
City
State
City
County
Zip Code
Phone
Zip Code
Phone
6. PERSONAL PROPERTY IS
OWNED
LEASED
IF LEASED, PROVIDE DESCRIPTION OF PROPERTY AND ATTACH A COPY OF THE LEASE AGREEMENT.
7. LEGAL DESCRIPTION OF REAL PROPERTY AS USED BY THE COUNTY ASSESSOR:
County Assessor’s Parcel Number:
County Assessor’s Legal Description:
Describe how each parcel of property is used:
(Use attachments if necessary)
Yes
No
If yes, complete this section.
8. ARE BUILDINGS PLANNED OR UNDER CONSTRUCTION?
Proposed beginning date of construction:
Date construction was started:
Proposed date of completion:
ATTACH ACCURATE SITE PLAN
9. DATE PROPERTY WAS PURCHASED:
Date property was actually used for exempt purpose:
10. WAS THIS PROPERTY PREVIOUSLY EXEMPT?
11. NAME OF PREVIOUS OWNER:
Yes
No
REV 63 0001-1 (10-3-96)