State of Oklahoma
Report for Charitable
Residential Rental Accommodations
Legal Description:
School
District
Occupancy Rate Affidavit
I, the undersigned, am personally acquainted with the use of the property hereinafter described, to wit:
(Mailing Address) _____________________________________________________________________________
_____________________________________________________________________________
(Physical Address) ____________________________________________________________________________
_____________________________________________________________________________
Phone Number: _______________________ Email Address: _______________________________________
If the owner of any charitable residential rental accommodations subject to the requirements in 68 O.S., Section 2887
subsection 8, requests Ad Valorem Tax exemption pursuant to the above title and section, such owner is subject to
submission of this form to the county assessor no later than December 15.
Please respond to the following questions:
I . Was the property occupied as of January 1 of the current year? ....................................................... Yes No
2. Is the property a single-family residential dwelling? ........................................................................... Yes No
3. Is the property a multi-family residential dwelling? ............................................................................ Yes No
4. If multi-family, what is the number of residential units? ____________________________ .
5. Does the property satisfy the income standards set-forth in Internal Revenue Service
Revenue Procedure 96-32? ............................................................................................................... Yes No
6. What is the average occupancy rate for the previous eleven (11) months, based on the
total number of units suitable for occupancy? ___________________________________ .
7. If the occupancy rate is less than seventy-ve percent (75%) the property shall not be exempt.
If the property provides residential rental accommodations or is subject to the occupancy requirements re-
quired in 68 O.S. , Sec. 2887 subsection 8, the owner shall submit a copy of this form to the county assessor
by December 15 of each year requesting an exemption. Any information stated or implied is subject to audit by
the county assessor.
I, ___________________________________________ being duly sworn upon oath, under the penalties of perjury,
do hereby depose and say that I am __________________________________ of __________________________,
that as such I am acquainted with the books, accounts and affairs of said entity or institution and know the above state-
ments to be true, correct and complete, and that all information requested herein has been fully and completely given
and I understand this is an annual afdavit that must be led with the county assessor each year by December 15.
Signature _______________________________________________________ Date ___________________
✍
Real Estate
Account:
Company
Name:
Tax Year
2020
Revised 11-2019
OTC 988-A
