Texas Comptroller of Public Accounts
Form
50-282
For more information, visit our website: comptroller.texas.gov/taxes/property-tax
Page 2
50-282 • 04-17/7
STEP 3: Property Information
• Attach one Schedule A form for each parcel of real property to be exempt.
• Attach one Schedule B form listing all personal property to be exempt.
STEP 4: Questions About the Organization
1. Is the association exempt from federal income taxation under Internal Revenue Code of 1986 Section 501(a), as an
organization described by Section 501(c)(3)? .................................................................
Yes
No
2.
In the past year has the association loaned funds to, borrowed funds from, sold property to or bought property from a
shareholder, director or member of the association or had a shareholder or member sell an interest in the association
for a prot?
............................................................................................
Yes
No
If yes, attach a description of each transaction. For sales, give buyer, seller, price paid, value of the property sold and date
of sale. For loans, give lender, borrower, amount borrowed, interest rate and term of loan. Attach a copy of note, if any.
3. Does the association provide assistance to ambulatory health care centers that provide medical care to individuals without
regard to the individuals’ ability to pay, including providing policy analysis, disseminating information, conducting continuing
education, providing research, collecting and analyzing data or providing technical assistance to the health care centers? .....
Yes
No
4.
Is the association funded wholly or partly, or assists ambulatory health care centers that are funded wholly or partly, by a
grant under Public Health Service Act Section 330 (42 U.S.C. Section 254b) and its subsequent amendments? .............
Yes
No
5.
Does the association perform abortions or provide abortion referrals or provide assistance to ambulatory health care centers
that perform abortions or provide abortion referrals?............................................................
Yes
No
6.
Does the association perform or does its charter permit it to perform any function other than ambulatory health care center
assistance?............................................................................................
Yes
No
If yes, attach a statement describing the other functions in detail.
7. Does the organization operate in such a manner that does not result in the accrual of distributable prots, the distribution of
prots or the realization of any other form of private gain? .......................................................
Yes
No
STEP 5: Questions About the Organization’s Bylaws or Charter
Attach a copy of the charter, bylaws or other documents adopted by the organization which govern its affairs and answer the following questions.
1. Does the organization use its assets in providing its assistance to ambulatory health care center functions or assistance
to ambulatory health care center functions of another organization?................................................
Yes
No
2.
Do these documents direct that on the discontinuance of the organization, the organization’s assets are to be transferred
to the state of Texas, the United States or an educational, religious, charitable or other similar organization that is qualied
for exemption under Internal Revenue Code Section 501(c)(3), as amended?
........................................
Yes
No
If yes, provide the page and paragraph numbers. Page
___________ Paragraph ___________
3. If no, do these documents direct that on discontinuance of the organization, the organization’s assets are to be transferred to
its members who have promised in their membership applications to immediately transfer them to the State of Texas, the
United States or an educational, religious, charitable or other similar organization that is qualied for exemption under
Internal Revenue Code Section 501(c)(3), as amended?
........................................................
Yes
No
If yes, provide the page and paragraph numbers. Page
___________ Paragraph ___________
4. If yes, was the two-step transfer required for the organization to qualify for exemption under Internal Revenue Code
Section 501(c)(3), as amended? ...........................................................................
Yes
No
5.
Does the organization operate, or does its charter permit it to operate, in such a manner as to permit the accural of prots,
the distribution of prots or the realization of any other form of private gain? .........................................
Yes
No
STEP 6: Certication and Signature
By signing this application, you designate the property described in the attached Schedules A and B as the property against which the exemption for
ambulatory health care center assistance associations may be claimed in the appraisal district. You certify that the information provided in this application
is true and correct to the best of your knowledge and belief.
_____________________________________________________ ____________________________________
Print Name Title
_____________________________________________________ ____________________________________
Authorized Signature Date
If you make a false statement on this application, you could be found guilty of a Class A misdemeanor or a state jail felony under Penal Code
Section 37.10.
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