12. Are any of your funds used or distributed for any monetary gain or profit to the members? Yes □ No □
Or for any purpose other than those set forth herein? _____________________________________________
13. Is any portion of the property not used by the applicant? Yes □ No □
If so, briefly describe the unused portion ______________________________________________________
14. If the applicant is a church, describe any portion of the property not actually used in worship services. (For
example: parking lots, minister’s residence, or vacant land.) _____________________________________
15. Is the property, or any part thereof used at any time for any other than the purposes set forth herein?
Yes□ No□ If so, describe such use _______________________________________________________
16. Is any part of the property used for recreation of the members? Yes□ No □
If so, describe the portion so used and the extent of the recreational use. _____________________________
17. Is any portion of the property occupied, rented or leased to anyone other than the applicant? Yes□ No□
If so, please describe particulars and provide copies of the signed leases or agreements.
18. Attach two (2) copies of any supplementary information you wish the Board to consider as part of your
application. Please provide a copy of your State Sales & Use Tax Certificate if you are applying for
Exemption as a non-profit 501(c)3 organization
19. In what manner does this institution (a) advance a charitable purpose; (b) donate or render gratuitously a
substantial portion of its services; (c) benefit a substantial and indefinite class of persons who are legitimate
subjects of charity; (d) relieve the government of some of its burden; and (e) operate entirely free from the
profit motive? (Please attach appropriate documentation in support of these statements.)
NOTICE: This application must be accompanied by a non-refundable Filing Fee (make checks payable to County of Erie) for
processing before it is considered a valid Exemption Application, per County Council Ordinance No. 157-2007. The filing fee is
$50.00 per parcel, or where several parcels comprise a property as a whole, $50.00 for the main parcel plus $10.00 for each
additional parcel that comprises the whole. If you are eligible for accommodation under the AMERICANS WITH DISABILITIES
ACT please contact us immediately so that arrangements may be made.
I certify that the above statements are true to the best of my knowledge.
Please Complete and Return to:
Erie County Board of Appeals
Erie County Court House
140 West Sixth St., Room 104
Erie PA 16501-1097