APPLICATION FOR EXEMPTION
Office Use Only
_______ - ___________________________
I.D.
Received By: ________________________
FROM
ERIE COUNTY REAL PROPERTY TAXES
Erie County Board of Assessment Appeals
Assessment Bureau
Erie County Court House
140 West Sixth Street, Room 104
Erie, Pennsylvania 16501-1097
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.
1. County Index Number: I.D. Map Block Parcel _____________
2. Location of Property ____________________________________________________________________
Phone
3. Name of Owner __________________________________________________Number ________________
Phone
4. Name of Applicant _______________________________________________ Number ________________
(Please Print) Phone
5. Correspondence should be mailed to: Name____________________________________________ Number _________________
_________________________________________________________________________________________
Address City State Zip Code
6. Property Description: Lot Size _______________________Building Size _______________________
7. Date of Permit _____________Permit Number ______________Proposed Completion Date ____________
(Copy of Building Permit must be attached.)
Single Family Unit ______Multi Family Unit __________Intended Purpose: Resale ______ Rental _______
Builder must give written notice to the Assessment Office when building is sold, occupied, rented or
leased, and/or submit copies of all leases if applicable. If multi-unit rental, please give written
notice to the Assessment Office as each unit is occupied.
NOTE: Builders Exemptions No additional information is required. Please sign and return.
8. Describe Use of Building _____________________________________________________
__________________________________________________________________________
Describe Use of Land (including any parking lots) _________________________________
__________________________________________________________________________
9. State the reason why you believe this property, or a part thereof, should be exempt.
_______________________________________________________________________________________
_______________________________________________________________________________________
10. Receipts and Disbursements: (Note: Churches need not complete Item 10)
A) Attach list of source and amounts of receipts for your preceding fiscal year.
B) Attach list of the recipient and amount of disbursements for the same period.
-See Reverse Side-
11. Attach a copy of your Charter. (If none, then attach copy of the by-laws.)
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
Signature Date
____________________________________________________________
Signature Date
Rev. 01/08