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STATE OF WISCONSIN

PROPERTY TAX EXEMPTION REQUEST

State law requires owners seeking exemption of a property for the current assessment year to file this form along with any necessary

attachments. Failure to complete this form in its entirety may result in denial of exemption. The completed form and attachments must be filed with the assessor in the taxation district where the property is located by March 1 to be eligible for the current assessment year. See sec. 70.11, Wis. Stats., and the Wisconsin Property Assessment Manual for additional property tax exemption information. If more space is needed for any questions, use the “Additional Information” box on page 4 or attach additional sheets.

SECTION 1 – APPLICANT INFORMATION

5.Mailing address and phone number of Applicant if different than Contact Person:

6.Identify each organizational officer, the officer’s address, the telephone number and the position held within the requesting organization.

7b. Identify the precise statutory reference and language supporting the exemption.

14.Do you provide service to anyone at below market or reduced rates?   Yes  No   N/A

If Yes, explain:

SECTION 4 – ATTACHMENTS

31.ATTACH COPIES OF THE FOLLOWING DOCUMENTS:

A.Documents regarding applicant, owner, tenant(s), or occupant(s) of the Subject Property (where applicable):

1.Proof of non-profit status (e.g. Determination Letter under I.R.C. 501(c)(3)).

2.Partnership Agreement, Association Documents, Articles of Incorporation, Charter and By-laws, including any amendments thereto.

3.Latest annual report filed with State Department of Financial Institutions.

4.Curriculum of educational courses offered.

5.Part II of Form 1023 (Application for Recognition of Exemption) filed with the Internal Revenue Service.

6.Form 990 (Return of Organization Exempt from Income Tax).

7.Form 990T (Exempt Organization Business Income Tax Return).

8.Ordination papers for the occupants if the Subject Property is to be considered eligible as housing for pastors and their ordained assistants, members of religious order and communities, or ordained teachers.

9.Leases and subleases affecting the Subject Property or any part thereof, including all amendments thereto.

10.Concessionaire agreements, license agreements, and other documents regarding the use of occupancy of the Subject Property or any part thereof, including all amendments thereto.

11.Covenants, restrictions, rules and regulations (recorded or unrecorded), and all amendments thereto, affecting use or occupancy of the Subject Property or title thereto and all amendments thereto.

12.Mortgages (recorded or unrecorded) affecting the Subject Property.

13.Copy of the documents listed in 1 through 12 above as the same relate to any tenant or occupant of the property.

14.Any other information that would aid in determining exempt status.

B.Documents regarding the Subject Property:

1.Survey of the Subject Property. This includes certified survey maps and subdivision maps and plats.

2.An Appraisal of the Subject Property.

3.Deeds or instruments of conveyance by which organization acquired interest in the Subject Property.

4.Any other information that would aid in determining exempt status.

SECTION 5 – AFFIDAVIT

Under penalties of perjury, I, on behalf of the above-named organization/Applicant, hereby certify that I am authorized to sign and submit this application, and that the information and documents submitted herewith are true and correct to the best of my knowledge and belief.

STATE OF WISCONSIN

COUNTY OF:

Note: The following text is an excerpt from Stat., Sec. 70.11. Refer to current Wisconsin Statutes for the complete language or sections applicable to the exemption of property from taxation.

70.11Property exempted from taxation. The property described in this section is exempted from general property taxes if the property is exempt under sub. (1), (2), (18), (21), (27) or (30); if it was exempt for the previous year and its use, occupancy or ownership did not change in a way that makes it taxable; if the property was taxable for the previous year, the use, occupancy or ownership of the property changed in a way that makes it exempt and its owner, on or before March 1, files with the assessor of the taxation district where the property is located a form that the department of revenue prescribes or if the property did not exist in the previous year and its owner, on or before March 1, files with the assessor of the taxation district where the property is located a form that the department of revenue prescribes. Except as provided in subs. (3m)(c), (4)(b), (4a) (f), and (4d), leasing a part of the property described in this section does not render it taxable if the lessor uses all of the leasehold income for maintenance of the leased property, construction debt retirement of the leased property or both and if the lessee would be exempt from taxation under this chapter if it owned the property. Any lessor who claims that leased property is exempt from taxation under this chapter shall, upon request by the tax assessor, provide records relating to the lessor’s use of the income from the leased property.

Additional information: