ANNUAL CLAIM FOR EXEMPTION FROM PROPERTY TAXATION
To Be Filed with the County Appraiser on or before March 1st
See other side for instructions
Name & Address of Taxpayer: County: ___________________
_____________________________________ Parcel I.D. No.: ___________________
_____________________________________ Personal Prop No.: ___________________
_____________________________________ Tax Year: ___________________
County Use Only
Description on file Check if Yes
If Yes mail copy of form and written statement to PVD
NOTICE
This Annual Claim for Exemption by law must be accompanied by:
(1) A Written Statement See instructions, other side and
(2) A Description/List of Exempt Property See instructions, other side
1. I (we) __________________________________, do hereby file a claim for property tax exemption for the tax
year ______, on the attached list of property.
2. The basis for the exemption is:
Kansas Court of Tax Appeals Order, Docket No. ________________________.
3. The Court Order indicates that the property is exempt pursuant to:
A. K.S.A. 79-201a Second (Industrial Revenue Bond-Funded Property)
B. Article 11, Section 13 of the Kansas Constitution
C. K.S.A. 79-221 (Certain Leased Property)
D. Other _____________________________ (explain).
4. The period of exemption set forth in the Court’s Order is:
________________________ through _____________________.
5. If the property is only partially exempt or if a payment in lieu of tax must be made, please attach the agreement
and/or uniform policy setting forth the terms.
6. Are you filing a claim for any property acquired after the Kansas Court of Appeals issued the order exempting
disclosed in number 2 above? ________. If yes, please explain why you believe this property is exempt.
7. Has the ownership of the property for which you are filing a claim for exemption changed in the past year?
______________. If yes, attach a full explanation.
8. Has the use of the property for which you are filing a claim for exemption changed in since the Court determined
that it was exempt? _____________. If yes, attach a full explanation.
I do hereby assert that the information furnished by me herein and in the attached schedules is
true, accurate, and complete.
Applicant’s Signature ________________________________ Date:
_______________
Name & Title ________________________________ Phone: _______________
PV-AD-1
(Rev. 3/2013)
Instructions
1. Who must file an Annual Claim for Exemption?
K.S.A. 79-210 requires owners of property that is exempt for a specified period of years to file an annual claim for
exemption, except for property exempted under:
(1) K.S.A. 79-201g (dam and reservoir land) or
(2) K.S.A. 79-201d Second (farm storage and drying equipment).
Owners of property exempted for economic development purposes pursuant to Article 11, Section 13 of the Kansas
Constitution, or property exempted by virtue of being funded with industrial revenue bonds pursuant to K.S.A. 79-
201a Second must file an annual claim for exemption.
2. When must the Annual Claim for Exemption be filed?
The annual claim for exemption must be filed with the county appraiser on or before March 1st. The failure to file the
annual claim for exemption may be just cause for the county appraiser to be in doubt as to whether the property
continues to meet the terms and conditions of exemption. When in doubt, the county appraiser must construe in favor
of taxation. (See Directive No. 92-025).
3. What items must accompany an Annual Claim for Exemption?
A written statement from the clerk of the city or county originally approving the exemption, and a description/list of
the exempt property.
4. What is a “Written Statement?”
K.S.A. 79-210 requires the annual claim for exemption to include a written statement signed by the clerk of the city or
county approving the exemption. The written statement from the city or county clerk must indicate whether the
property sought to be exempt continues to meet all the terms and conditions of exemption.
Each year, the applicant should obtain a written statement from the appropriate city or clerk indicating whether the
terms and conditions of exemption continue to be satisfied. The written statement should be submitted to the county
appraiser along with the annual claim for exemption.
The terms and conditions of exemption should also be submitted to the county appraiser. It is acceptable to just
submit the terms and conditions to the county appraiser once during the period of exemption, not every year, unless
the terms and conditions are revised. When revisions occur, they should be submitted to the county appraiser by the
following March 1st, along with the annual claim for exemption.
5. What constitutes a “Description/List of Exempt Property?”
The description/list of exempt property that is submitted with the annual claim should be the description and/or list of
property that was issued with the Kansas Court of Tax Appeals Order. If the description of the item(s) listed by the
Court is vague, the applicant must provide further information. The description/list of exempt property should include
(complete the exempt real property form):
1. The legal description of any land exempted and the date it was acquired;
2. A brief description of any improvements (i.e., buildings) and the date they were completed;
3. A list of all exempt personal property setting forth for each item:
a. A brief description
b. The date of purchase
c. Whether the item was purchased new or used
d. The age at the date of purchase
e. The purchase price (exclude sales tax or freight & installation that are charged separately)
Note: only the property specifically exempted by the Kansas Court of Tax Appeals qualifies for exemption. Property
purchased subsequent to the Court’s order and not addressed therein is not exempt.
Supplemental Form (Revised 3/2013) ExemptRP.doc
EXEMPT REAL PROPERTY FORM
Supplemental page
If more than one building exists on a parcel identification number (PIN), please report only
one building on each copy of the Exempt Real Property Form. The requested information is
parcel specific. Make as many copies of this form as is necessary to report your exempt real
property.
Firm Name: ________ ____ Parcel Id. #: ________________________________________
Docket Number: ______________________________ Exempt Period: ____________________________________
Legal Description:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
__________________________________________________________________________________________
Is land acquisition associated with this exemption? Yes ____No ____
If land acquisition is associated with this exemption, then provide the following information:
What date was the land purchased? _____________________________________________
What was the purchase price of the land? ________________________________________
If this is an Industrial Revenue Bond (IRBX) exemption, provide the amount of bond
funds spent on this parcel of land associated with this docket number:
___________________
If an improvement(s) is/are associated with this exemption, then provide the following information:
Building name and number (if applicable): ________________________________________
Description of the improvement: __________________________________________________________
__________________________________________________________________________________________
Date of completion: ______________________________________________________________________
Total square footage of the improvement: _________________________________________________
Provide the total cost of the improvement attributable to the exemption under this docket
number:_________________________________________________________________________________
If this is an Industrial Revenue Bond (IRBX) exemption, provide the amount of bond
funds spent on the improvement associated with this docket number:
____________________
If an in-lieu-of payment agreement is associated with this exemption provide the following
information:
Amount of in-lieu-of tax payment for _____ for this parcel: _________________________________
Please attach a copy of the in-lieu-of tax agreement.
I do hereby assert that the information furnished by me herein and in the attached schedules
is true, accurate, and complete.
Applicant's Signature _____________________________ Date: _____________________
Name & Title _____________________________ Phone: _____________________