2. Application for Property Tax Exemption
4. This application must be filed with the assessor every year by February 1 of the year for which the exemption is claimed.
6. Property Number:*
8. Property Owner:*
10. Property Address:*
12. Legal Description
14. Current e-mail:*
16. Current telephone number:*
18. Date property was acquired:
19. Market value of property claimed exempt: $
21. Exemption Claimed Pursuant to One of the Following Sections of the North Dakota Century Code:
23. 1. Church

    1. 1. N.D.C.C. 57-02-08(9), property used exclusively for public worship or property belonging to a religious organization and used for religious purposes (choose one answer below):
    2. Church
    3. Parsonage
    4. Other(attach explanation)
25. 2. Public Charity

    1. 2. N.D.C.C. 57-02-08(8), property owned by an institution of public charity and used for the charitable purposes for which it was organized (choose one answer below):
    2. Public Hospital
    3. Nursing Home
    4. Other
27. 3. Non-Profit

    1. 3. N.D.C.C.57-02-08(11), property owned by non-profit lodges, clubs, etc. and used for their meetings and ceremonies:
30. a. If licensed to sell alcoholic beverages, decribe each area of the building where these beverages are sold or consumed.
33. b. If food is sold, descibe each area of the building where food is sold or consumed.
35. 4. Paraplegic

    1. N.D.C.C.57-02-08(20), buildings owned and occupied as a homestead by one of the following (choose one answer below):
    2. Paraplegic Disabled Veteran or Veteran awarded a specially adapted housing or unremarried survivng spouse.
    3. Permanently and Totally Disabled Person Confined to a Wheelchair or unremarried survivng spouse.
37. 5. Blind

    1. 5. N.D.C.C.57-02-08(22), buildings owned by a blind person and/or spouse and occupied as a home by the blind person.
39. 6. Paraplegic Disabled Person

    1. N.D.C.C.57-02-08(26), buildings owned and occupied as a homestead by a paraplegic disabled person or unremarried surviving spouse.
41. 7. Group Homes

    1. N.D.C.C.57-02-08(31), group homes owned by non-profit corporations.
43. 8. Mobile Home

    1. N.D.C.C. 57-55-10, mobile home is exempt or the provisions of N.D.C.C. ch. 57-55 apply.
45. 9. Other
46. N.D.C.C.
47. Subsection
49. For what purpose(s) was the property used during the 12-month period prior to the year for which this exemption is claimed? (Note: Be specific. If there were several types of use, indicate usages by square foot areas of the building and floor location. If additional space is needed, attach another sheet.)
51. Is any income derived from the use of any portion of this property by other individuals or groups, whether considered as rent or reimbursment for expenses or services rendered?
53. (1) Provide a current copy of organizational documents supporting claim (e.g. articles of incorporation and by-laws, etc.) if claiming exemption for the first time or upon request.
55. (2) Provide an affidavit or physician's certificate if claiming exemption for first time.
57. (3) Provide an annual statement that previous year's income did not exceed the amount provided in N.D.C.C. 557-02-08.1.
59. (4) Provide a copy of the DD Form 214 showing veteran's honorable discharge from active military service if claiming exemption for first time.
61. (5) Provide evidence from the Department of Veteran's Affairs showing award of specially adapted housing if claiming exemption for this status for first time.
63. (6) A person shall furnish to the assessor or other assessment officials when requested to do so any information that is believed will support the claim for exemption for a subsequent year.
65. I (We) make application for real property tax exemption for the year (selected below) on the described property and, in compliance with North Dakota Century Code 57-02-14.1, certify the information is accurate to the best of my (our) knowledge and belief.*
    -- Select One --202020212022
67. Note: N.D.C.C.12.1-11-02 provides that making a false statement in a governmental matter is punishable as a Class A misdemeaner.
69. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
71. Electronic Signature*
72. Date*
    Date
74. Upload Additional Documents
78. 24740 (Rev.3-12)
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80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit

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