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County name DTE 23 Rev. 4/05 Application for Real Property Tax Exemption and Remission Office Use Only County application number DTE application number Date received by county auditor Date received by DTE 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 treasurer's 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 owner's 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 taxexempt list for the current tax year, and to have the taxes and penalties thereon remitted for these preceding tax years: Applicant Name: Name Notices concerning this application Name (if different from applicant) should be sent to: Address City 1. Parcel number(s). (If more than four, continue on an attached sheet. All parcels must be in the same school district. a) b) c) d) State ZIP Telephone number 2. School district where located 3. Total size of parcel(s) 4. Street address or location of property -1American LegalNet, Inc. www.FormsWorkFlow.com Less than ONE acre One acre or MORE Number of acres DTE 23 Rev. 4/05 5. a) Title to this property is in the name of b) Address of owner 6. If title holder is different from the applicant, please explain 7. Title holder is (check one): A nonprofit corporation An individual An unincorporated association/organization Other 9. Title was acquired from 8. Exact date title was acquired Please attach copy of the deed. 10. Does the applicant have a lease or land contract for this property? Yes No If yes, please attach a copy. 11. Amount paid by title holder for the property 12. Exact date the exempt use began 13. Under what section(s) of the Ohio Revised Code (R.C.) is exemption sought? R.C. R.C. R.C. 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. 15. During the years in question, was any part of this property (check one): a) Leased or rented to anyone else? Yes No If yes, please attach copy of lease agreement. b) Used for the operation of any business? Yes No c) Used for agricultural purposes? Yes No d) Used to produce any income other than donations? Yes No Note: 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? If yes, answer the following: a) The person's name and position b) The resident's duties (if any) in connection with this property c) The rent paid or other financial arrangements 17. Is anyone using this property other than the applicant? If yes, please enclose a complete, detailed explanation. Yes No Yes No Yes No 18. Does the applicant own property in this county that is already exempt from taxation? 19. Property use for charitable purposes. Please provide articles of incorporation, constitution or bylaws, 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. -2American LegalNet, Inc. www.FormsWorkFlow.com DTE 23 Rev. 4/05 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. I declare under penalty of perjury that I have examined this application and, to the best of my knowledge and belief, it is true, correct and complete. Applicant or representative: Signature Print name and title Address City Telephone number State ZIP Date County Auditor's Finding Land Taxable value in year of application Taxable value in prior year (tax year) (tax year) Building Total This application covers property that is (check all that apply): Currently exempt* Previously exempt New construction on previously exempted parcel Currently on CAUV Previously on CAUV Auditor's Recommendation: Grant Comments: Partial grant Deny None County auditor (signature) Date Forward 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. -3- American LegalNet, Inc. www.FormsWorkFlow.com DTE 23 Rev. 4/05 Treasurer's Certificate If the Treasurer's Certificate is not properly filled out and signed, the tax commissione