Initial Statement Of Organization Claiming Property Tax Exemption {IS}

INITIAL STATEMENT OF ORGANIZATION CLAIMING PROPERTY TAX EXEMPTION (N.J.S.A.54:4-4.4; & 54:4-3.5; 54:4-3.6; 54:4-3.6a; 54:4-3.9; 54:4-3.10; 54:4-3.13; 54:4-3.15; 54:4-3.24; 54:4-3.25; 54:4-3.26; 54:4-3.27; 54:4-3.35; 54:4-3.52; 54:4-3.64; & N.J.S.A.8A:5-10 et al) IMPORTANT File this claim in duplicate with municipal assessor of taxing district where property is located by November 1 of the pretax year. Separate claims must be filed for each parcel. Every third year as of November 1 a Further Statement updating the organization's status must be filed with the assessor. See instructions. 1. CLAIMANT ORGANIZATION NAME __________________________________________________________________________________________________ 2. ORGANIZATION ADDRESS (Corporate Headquarters) __________________________________________________________________________________________________ 3. CONTACT INDIVIDUAL, REPRESENTATIVE, OFFICER for ORGANIZATION __________________________________________________________________________________________________ Name Phone # E-Mail Address Fax # __________________________________________________________________________________________________ Postal Mailing Address __________________________________________________________________________________________________ 4. INCORPORATION A. Domestic-Incorporated or organized in New Jersey on (month/day/year) _________under statute cite #_____________ B. Foreign-Incorporated or organized in the state of ______________ on (month/day/year) ________________________ Registered with New Jersey Secretary of State on (month/day/year) ___________________________________________ 5. ORGANIZATION'S PURPOSES (Explain organization's purposes. Attach Certificate of Incorporation, Articles of Association, Charter/Mission Statement, and Constitution & By-laws.) __________________________________________________________________________________________________ __________________________________________________________________________________________________ 6. NEW JERSEY STATUTE UNDER WHICH PROPERTY TAX EXEMPTION IS CLAIMED State New Jersey statute cite # and brief description (see list in instructions) __________________________________________________________________________________________________ 7. PROPERTY LOCATION IN NEW JERSEY __________________________________________________________________________________________________ Street Address City Zip Code __________________________________________________________________________________________________ County Municipality Block # Lot # Qualifier 8. PROPERTY OWNERSHIP Grantor (Seller) _______________________________ Grantee (Buyer) _______________________________________ Deed Date (Month/Day/Year) ____________________ Deed Book _________________ Page _______________ County of recording ____________________________ Recording Date _______________________________________ Owner of legal title ! Yes ! No If no, describe ownership arrangement. Attach ownership document. __________________________________________________________________________________________________ 9. PROPERTY'S PHYSICAL DESCRIPTION Total Land Area (Sq. Ft./Acreage) _____ Land is ! Vacant or ! Improved with buildings and/or structures? (Check one) If improved, state number of buildings and/or structures ____________________________________________________ State each building size in square feet ___________________________________________________________________ Fully describe each building/structure type _______________________________________________________________ State $ amount for which improvements are insured __________________ 10. PROPERTY'S ACTUAL USE or ACTUAL/EXCLUSIVE USE If vacant land, state uses and area size for each use. If not used, state none. _____________________________________ If improved with buildings and/or structures, state uses of each. ______________________________________________ __________________________________________________________________________________________________ Are land and/or buildings used for stated purposes of claimant organization per section 5 above? ! No ! Yes If yes, ! Entirely or ! Partially? Explain if used for other than claimant organization's purposes or if used or occupied by other than the claimant organization ____________________________________________________ __________________________________________________________________________________________________ Are land and/or buildings leased or rented by other than claimant organization? ! No ! Yes Attach copy lease/rental agreement. If yes, ! Entirely or ! Partially? Percentage of property leased ____% Explain rental uses. _________________________________________________________________________________ State tenant names and rental income received. __________________________________________________________________________________________________ Is commercial business conducted on premises? ! No ! Yes If yes, explain __________________________________ 11. COMPENSATION, REMUNERATION RECEIVED List names of individuals, officers, entities receiving compensation, salaries, allowance, monetary profits from claimant organization and dollar amounts received. If none, state none. Supporting financial data may be required by assessor. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 12. SIGNATURE, DATE & TITLE OF OFFICER CLAIMING EXEMPTION FOR ORGANIZATION I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as if made under oath and subject to penalties for perjury if falsified. Signature________________________________ Official Title or Position ______________________Date__________ __________________________________________________________________________________________________ Official Use ! Denied ! Approved Exempt Property Code_____________________________ Assessor______________________________________________________________________Date_________________ Form I.S. Rev. December 2001. This form is prescribed by the Director, Division of Taxation, as required by law, and may not be altered without the approval of the Director. American LegalNet, Inc. www.FormsWorkflow.com INFORMATION/INSTRUCTIONS GENERAL ELIGIBILITY