General Instructions
Submit two copies of this application to the auditor’s oce in the county where the property is located. (Make a copy for
your records.) Applications should not be led until the year following acquisition of the property. The nal deadline for l-
ing with the county auditor is Dec. 31 of the year for which exemption is sought. If you need assistance in completing this
form, contact your county auditor.
• Both the County Auditor’s Finding (page 3) and the Treasurer’s Certicate (page 4) of this application must be completed.
Ask your county auditor for the procedure to follow to obtain the Treasurer’s Certicate. When presented with this applica-
tion, the county treasurer should promptly complete the certicate and return the application to you so it may be led with
the county auditor. The county treasurer should make certain the treasurer’s certicate is complete and accurately reects
the payment status of taxes, special assessments penalties, and interest, by tax year. Obtain a copy of the property re-
cord card from the county auditor and enclose it with this application. It is the applicant’s responsibility to make sure the
information supplied by the county auditor and county treasurer is complete and accurate.
• Answer all questions on the form. If you need more room for any question, use additional sheets of paper to explain details.
Please indicate which question each additional sheet is answering. This application must be signed by the property owner
or the property owner’s representative.
Please Type or Print Clearly
Application is hereby made to have the following property removed from the tax list and duplicate and placed on the tax-
exempt list for the current tax year, and to have the taxes and penalties thereon remitted for these preceding tax years:
Name (if dierent from applicant)
City State ZIP Telephone number
Email Address
If the county auditor is in possession of an email address for you, the auditor may choose to send you
Important notices about your application by email and regular mail instead of by certied mail.
2. School district where located
3. Total size of parcel(s) £ Less than ONE acre £ One acre or MORE Number of acres
Application for
Real Property Tax Exemption and Remission
Oce Use Only
County application number
DTE application number
Date received by DTEDate received by county auditor
County name
- 1 -
Applicant Name:
Notices concerning
this application
should be sent to:
1. Parcel number(s).
(If more than four,
continue on an attached
sheet.) All parcels
must be in the same
school district.
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Rev. 01/19
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4. Street address or
location of property
5. a) Title to this property is in the name of
b) Address of owner
6. If title holder is dierent from
the applicant, please explain
7. Title holder is £ A nonprot corporation £ An unincorporated association/organization
(check one):
£ An individual £ Other
8. Exact date title was acquired 9. Title was acquired from
Please attach copy of the deed.
10. Does the applicant have a lease or land contract for this property?
If yes, please attach a copy.
11. Amount paid by title holder for the property
12. Exact date the exempt use began
13. Under what section(s) of the Ohio Revised Code (R.C.) is exemption sought?
R.C. R.C. R.C.
14. How is this property being used? Do not give conclusions such as charitable purpose, public worship or public purpose.
Be specic about what is being done on the property and who uses it. If the property is not currently being used, but
there is an intent to use it later for an exempt purpose, describe the intended use and the date set for the intended use.
15. During the years in question, was any part of this property (check one):
a) Leased or rented to anyone else? £ Yes £ No
If yes, please attach copy of lease agreement.
b) Used for the operation of any business? £ Yes £ No
c) Used for agricultural purposes? £ Yes £ No
d) Used to produce any income other than donations? £ Yes £ No
Note: If the answer to any part of question 15 is “yes,” enclose all details on a separate sheet of paper. If money
is received, submit prot and loss statements, income and expense data, balance sheets or any other nancial
16. Is anyone living or residing on any part of this property? £ Yes £ No
If yes, answer the following:
a) The person’s name and position
b) The resident’s duties (if any)
in connection with this property
c) The rent paid or other
nancial arrangements
17. Is anyone using this property other than the applicant?
£ Yes £ No
If yes, please enclose a complete, detailed explanation.
18. Does the applicant own property in this county that is already exempt from taxation?
£ Yes £ No
19. Property use for charitable purposes.
Please provide articles of incorporation, constitution or bylaws, IRS determination letter and any other similar relevant information.
20. Property used for senior citizens’ residences.
If the purpose of the property is to provide a place of residence for senior citizens, submit all information required by
R.C. section 5701.13.
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Rev. 01/19
The Ohio Department of Taxation may set a hearing on this application. If there is a hearing, the applicant must
present a witness who can accurately describe the use of the property in question. A notice of at least 10 days will
be given to the applicant concerning the time and place of any hearing.
I declare under penalty of perjury that I have examined this application and, to the best of my knowledge and belief, it is
true, correct and complete.
Applicant or representative:
Print name and title
City State ZIP
Telephone number Date
- 3 -
County Auditors Finding
This application covers property that is (check all that apply):
£ Currently exempt* £ New construction on £ Currently on CAUV
previously exempted parcel
£ Previously exempt £ Previously on CAUV
Auditors Recommendation:
£ Grant £ Partial grant £ Deny £ None
County auditor (signature) Date
Taxable value in year of application (tax year)
Taxable value in prior year (tax year)
BuildingLand Total
Forward one copy of the completed application to the Ohio Department of Taxation, Equalization Division, P.O. Box 530,
Columbus, OH 43216-0530.
*If the property or any portion of the property is currently exempt, please indicate the type of exemption, the portion of prop-
erty exempted and the tax years to which the current exemption applies.
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Rev. 01/19
If the Treasurers Certicate is not properly lled out and signed, the tax commissioner will have no jurisdiction to act
on the application, and it will be subject to dismissal.
(Notice to treasurer: The rst paragraph of this certicate must always be complete.)
I hereby certify that all taxes, penalties and interest levied and assessed against the above described property have
been paid in full up to and including the tax year . The most recent year for which taxes have been charged
is tax year .
I further certify that the only unpaid taxes, penalties and interest that have been charged against this property are
as follows:
If additional years are unpaid, please list on an attached sheet.
Have tax certicates been sold under R.C. 5721.32 or 5721.33
for any of the property subject to this application? Yes No
Are any unpaid taxes listed on this certicate subject to
a valid delinquent tax contract under R.C. 323.31(A)? Yes No
If yes, list tax years
County treasurer (signature) Date
Treasurers Certicate
Tax YearParcel Number
(including penalties
and interest)
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