FURTHER STATEMENT OF ORGANIZATION CLAIMING PROPERTY TAX EXEMPTION
(N.J.S.A
. 54:4-4.4; & 54:4-3.5; 54:4-3.6; 54:4-3.6a; 54:4-3.9; 54:4-3.10; 54:4-3.13; 54:4-3.15; 54:4-3.24; 54:4-3.25;
54:4-3.26; 54:4-3.27; 54:4-3.35; 54:4-3.52; 54:4-3.64; & N.J.S.A
. 8A:5-10 et al)
IMPORTANT File this claim in duplicate with municipal assessor of taxing district where property is located no later
than November 1 of every third succeeding year, updating the organization’s status. Separate claims must be filed for
each parcel. See instructions.
1. CLAIMANT ORGANIZATION NAME
__________________________________________________________________________________________________
2. ORGANIZATION ADDRESS (Corporate Headquarters)
__________________________________________________________________________________________________
3. CONTACT INDIVIDUAL, REPRESENTATIVE, OFFICER for ORGANIZATION
__________________________________________________________________________________________________
Name Phone # E-Mail Address Fax #
__________________________________________________________________________________________________
Postal Mailing Address
4. EXEMPT PROPERTY LOCATION IN NEW JERSEY for which continued exemption is claimed
__________________________________________________________________________________________________
Street Address City Zip Code
__________________________________________________________________________________________________
County Municipality Block # Lot # Qualifier
5. CONFIRMATION OF FILING OF INITIAL STATEMENT
Initial Statement claiming exemption from taxation for the above mentioned real property in item #4 was filed on
_____________________ with
the assessor of the aforementioned municipality.
(Date)
6. PHYSICAL and/or USE CHANGES of the aforementioned real property in item #4
Fully describe any physical changes that have occurred since the filing of the previous Initial or Further Statement.
Total Land Area (Sq. Ft./Acreage) ________________
Land is Vacant or Improved with buildings and/or structures? (Check one)
If improved, state number of buildings and/or structures ____________State building(s) size in square feet _____________
Fully describe building(s)/structure(s) type ________________________________________________________________
State $ amount for which improvements are insured _________________
Fully describe any changes in the use that have occurred since the filing of the previous Initial or Further Statement.
If vacant land, state purpose, area used and size for each use. If not used, state none ________________________________
___________________________________________________________________________________________________
If improved with buildings and/or structures, state uses of each.________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Are land and/or buildings used for originally stated purposes of claimant organization? No Yes
If yes, Entirely or Partially? Explain if used for other than claimant organization’s purposes or if used or occupied by
other than the claimant organization ______________________________________________________________________
___________________________________________________________________________________________________
Are land and/or buildings leased or rented by other than claimant organization? No Yes
If yes, Entirely or Partially? Percentage of property leased ______% Attach copy lease/rental agreement.
Explain rental uses____________________________________________________________________________________
State tenant names and rental income received.
___________________________________________________________________________________________________
Is commercial business conducted on premises? No Yes If yes, explain
___________________________________________________________________________________________________
7. COMPENSATION/REMUNERATION CHANGES
Fully describe any changes that have occurred since the filing of the previous Initial or Further Statement.
List names of individuals, officers, entities receiving compensation, salaries, allowance, monetary profits from claimant
organization and dollar amounts received. If none, state none. Supporting financial data may be required by assessor.
___________________________________________________________________________________________________
8. PROPERTY OWNERSHIP CHANGES/DISPOSITIONS
Has any portion of the real property described in item 4, for which exemption has previously been claimed and allowed,
been rented, sold or otherwise disposed of since the filing of the prior Initial or Further Statement? Yes No
If yes, describe the property and state to whom conveyed and date of conveyance. _________________________________
___________________________________________________________________________________________________
9. PROPERTY NEWLY ACQUIRED for which exemption is claimed
Has any new or additional real property been acquired by claimant since the filing of the previous Initial or Further
Statement? Yes No Property Location ______________________________________________________________
If yes, an Initial Statement, Form I.S., as to such new or additional real property must be filed with the assessor.
10. SIGNATURE, DATE & TITLE OF OFFICER CLAIMING EXEMPTION FOR ORGANIZATION
I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as if
made under oath and subject to penalties for perjury if falsified.
Signature_______________________________ Official Title or Position _______________________Date___________
Official Use Denied Approved Exempt Property Code______________________________
Assessor______________________________________________________________________Date__________________
Form F.S. Rev. April 2002. This form is prescribed by the Director, Division of Taxation, as required by law, and may not be altered
without the approval of the Director.
