Property Address of Property for Which Exemption is Sought
City State Zip Code County
Legal Description of Property (attach additional sheets if necessary) Parcel ID Number
Principal Use of the Property
Additional Uses of the Property (give percentage of use):
Are these uses directly related to the mission of the organization?
Yes No
How is the property used to acheive or further the organization’s mission?
Is the purpose to be helpful to others without expectation of material reward?
Yes No
List donations, gifts, or government grants received last year:
Donations:
Gifts (Monetary Value):
Government Grants:
If you do not receive any donations, gifts, or government grants, please describe how this organization is supported.
Owner/Property Information
Name of Organization Date Property Acquired by Organization
Representative or Owner Name Title Date of Application
Mailing Address of Organization
City State Zip Code County
Are you claiming exemption as an institution of purely public charity? Yes No
If no, le Form PTE, Application for Property Tax Exemption.
Is the above organization exempt from federal income tax under section 501(c)(3)?
Yes No
Please include your Articles of Incorporation and your Federal Form 990 with this application.
PTE-PC
Institution of Purely Public Charity
Application for Property Tax Exemption
(Rev. 5/13)
Please read the instructions before you complete this form. If you are not applying for exemption as an institution of purely
public charity, ll out Form PTE, Application for Property Tax Exemption.
Property Information
To be completed by all applicants
Property Uses
Continued
Charitible Organization
Information
For Ofce Use Only
Approved
Denied
Name of organization _____________________________Assessment year ____________
Assessor’s signature ______________________________Date _______________________
Sign Here
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 property or authorized representative of the organization that owns the property for which exemption is
being claimed.
Do you provide your goods or services for reduced or no cost? Yes No
If yes, provide an example:
If any of the recipients pay market value for your services, explain:
Are any of the organization’s prots (including donations, gifts, or income) distributed to private interests?
Yes No
Are the beneciaries of the charity restricted to any group of persons?
Yes No
If yes, explain the reason for restriction:
Upon dissolution, are dividends or assets made available to private interests?
Yes No
Charitible Organization
Information, Cont.
Institution of Purely Public Charity
Application for Property Tax Exemption (Continued)
PTE-PCp2
Filing for Exemption
An institution claiming exemption
from property taxes as an institution
of purely public charity must le an
application for exemption with the as-
sessor in the district where the property
is located on or before February 1 of the
assessment year.
is application must be led every
third year. No matter what year the
taxpayer initially les for exemption,
applications will again be due in 2010,
2013, 2016, etc.
You may attach any additional informa-
tion you feel is necessary to complete
this application, including descriptions
of the charitable activities of your orga-
nization.
If you are ling for property tax exemp-
tion as something other than an institu-
tion of purely public charity, please
inquire at your assessors oce for the
appropriate application form.
What Type of Property
Qualies?
Minnesota Statute 272.02, subdivision
7 describes the qualications neces-
sary for an institution of purely public
charity to be eligible for property tax
exemption. e organization must be a
501(c)(3) organization under the Inter-
nal Revenue Code and provide a charity
to the public. e ling requirements
for applications for exemption can be
found in Minnesota Statute 272.025.
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.
Required Documentation
e following documentation must
be included with your application for
exemption as a purely public charity.
IRS letter granting exempt status as a
501(c)(3) corporation, or an explana-
tion of why the letter is not available.
Articles of Incorporation for the facility
(and the parent corporation if appli-
cable).
Financial statements or other docu-
ments showing the most recent three
years of donations for the facility, the
total income and total expenses. (Feder-
al Form 990 with schedules or certied
nancial statements show this informa-
tion. Sworn statements from the donors
may be used to show donations.)
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. e assessor may also ask for any
information which would clarify ex-
planations provided under “Charitable
Organization Information.
e assessor will provide you with a
reasonable amount of time to provide
this additional information. You will
be notied in writing of your approval
or denial for property tax exemption. If
you disagree with the assessor’s deter-
mination, you may request an advisory
opinion from the Minnesota Depart-
ment of Revenue, or you may appeal
the assessor’s decision to Minnesota Tax
Court.
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.
Property which is subject to property
tax on January 2 that is acquired by a
government entity, institution of purely
public charity, church or educational
institution before July 1 of the year is
exempt for that assessment year if the
property is to be used for an exempt
purpose.
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 property
tax exemption. Your Social Security
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
additional verication of qualications.
Your Social Security number is consid-
ered private data.
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.
Instructions for Form PTE-PC