Fill - Free fillable Application for Property Tax Exemption for Nursing Homes (Minnesota Department of Revenue) PDF form

I certify that the above organization is exempt from federal income tax under section 501(c)(3). Yes No

You must be able to certify one of the following as being true in order to qualify for the exemption:

I certify that this facility is certied to participate in the medical assistance program under

title 19 of the Social Security Act.

Yes No

I certify that this facility does not discharge residents due to inability to pay.

Yes No

Property Information

Representative or Owner Last Name First Name Middle Initial

Title Name of Organization

Mailing Address

City State Zip code County

Parcel ID or legal description of property (from tax statement or valuation notice)

NBH

Application for Property Tax Exemption for Nursing Homes and

Boarding Care Homes

(Rev. 5/13)

Please read the instructions before you complete this form. Return to your county assessor by February 1.

Certications

To be completed by all applicants

Certications

Signature of Owner Phone Date

Signature of Owner or Authorized Representative

By signing below, I certify that the above information is true and correct to the best of my knowledge, and I am the owner of the prop-

erty or authorized representative of the organization that owns the property for which exemption is being claimed.

Sign Here

Include with this application a designation from the IRS proving status as a 501(c)(3) organization. Also include with this application

a copy of the facility’s discharge policy or proof that the facility is certied to participate in the medical assistance program under

title 19 of the Social Security Act.

For Ofce Use Only

Approved

Denied

Name of organization _____________________________Assessment year ____________

Assessor’s signature ______________________________Date _______________________

Filing for Exemption

Minnesota Statutes 272.02, subdivision

90 provides a property tax exemption to

qualifying nursing homes and boarding

care homes. e facility must be exempt

from federal income taxation pursu-

ant to section 501(c)(3) of the Internal

Revenue Code, and must meet one of

the following requirements:

• efacilityiscertiedtoparticipate

in the medical assistance program

under title 19 of the Social Security

Act; or

• efacilitycertiesthatitdoesnot

discharge residents due to the inabil-

ity to pay.

Applications are due February 1of the

assessment year. is application must

bere-ledeverythirdyear.Nomatter

whatyearthetaxpayerinitiallylesfor

exemption, applications will again be

due in 2013, 2016, 2019, etc.

In cases of sickness, absence, disability

or for other good cause, the assessor

mayextendthedeadlineforlingthe

statement of exemption for a period not

to exceed 60 days.

Required Documentation

You must provide the following docu-

mentation with this application:

• AdesignationfromtheIRSproving

status as a 501(c)(3) organization; and

either

• acopyofthefacility’sdischarge

policy showing that residents are not

discharged due to the inability to pay;

• proofthatthefacilityiscertiedto

participate in the medical assistance

program under title 19 of the Social

Security Act.

Nopropertywillbeexemptfromtaxa-

tion under Minnesota Statute 272.02

if the taxpayer claiming the exemption

knowingly violates any of the provisions

of this section.

Assessor May Request

Additional Information

Upon written request by the assessor,

taxpayers must make available to the

assessor all necessary books and records

relating to the ownership or use of

property which can help verify whether

ornotthepropertyqualiesforexemp-

tion.

Sale or Purchase of

Exempt Property

Property which is exempt from prop-

erty tax on January 2 and, due to sale or

other reason, loses its exemption prior

to July 1 of that year, will be placed on

the current assessment rolls for that

year.

e valuation will be determined with

respect to its value on January 2 of such

year.eclassicationwillbebasedon

the use to which the property was put

by the purchaser, or

in the event the purchaser has not uti-

lized the property by July 1, the intend-

ed use of the property, as determined

by the county assessor, based upon all

relevant facts.

Use of Information

e information on this form is re-

quired by Minnesota Statutes, section

272.02 to properly identify you and

determine if you qualify for this prop-

erty tax exemption. Your Social Secu-

rity number is required. If you do not

provide the required information, your

application may be delayed or denied.

Your County Assessor may also ask for

Penalties

Making false statements on this ap-

plication is against the law. Minnesota

Statutes, section 609.41 states that any-

one giving false information in order to

avoid or reduce their tax obligations is

subjecttoaneofupto$3,000and/or

up to one year in prison.

Questions?

Yourcountyassessor’soceshouldbe

abletoassistyouwithproperlylling

out this form.

Applying for Exemption from Property Tax

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Application for Property Tax Exemption for Nursing Homes (Minnesota Department of Revenue)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Application for Property Tax Exemption for Nursing Homes (Minnesota Department of Revenue) Form

Related forms

Fillable Application for Property Tax Exemption for Nursing Homes (Minnesota Department of Revenue)

Fill Online, Printable, Fillable, Blank Application for Property Tax Exemption for Nursing Homes (Minnesota Department of Revenue) Form

Related forms

First 20 documents completely FREE!