2.
Attach a list of salaries and other compensation for services paid in the last year. Also, list any funds distributed to members,
shareholders or directors in the last year. In each case, give recipient's name, type of service rendered or reason for payment and
amounts paid.
3.
In the past year has the organization loaned funds to, borrowed funds from, sold property to or bought property
from a shareholder, director or member of the organization, or has a shareholder or member sold his interest
in the organization for a profit?
a.
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.
4.
If operated by a corporation, is the corporation nonprofit as defined by the Texas Non-Profit Corporation Act
(Article 1396, Tex. Rev. Civ. Stat.)?
Harris County Appraisal District
Exemption Center
13013 Northwest Fwy.
P. O. Box 922012
Houston, TX 77292-2012
(713) 957-7800
FORM 11.30(01/2012)
Application for Nonprofit Water Supply or
Wastewater Service Corporation Property
Tax Exemption _______
This application covers property you owned on January 1 of this year, or acquired during this year. You must file the completed application
between January 1 and no later than April 30 of this year. If you acquire the property after January 1 of this year and wish to qualify for the
exemption this year, you must apply before
the first anniversary of the date you acquired the property, or before the first anniversary of the
date any property was acquired after January 1. Be sure to attach any additional documents requested. If the chief appraiser grants the
exemption, you do not need to reapply annually, but you must reapply if the chief appraiser requires you to do so, or if you want the
exemption to apply to property not listed in this application. You must notify the chief appraiser in writing if and when your right to this
exemption ends. If you have filled out this form online, you must print it, sign it, and mail it to the address above.
* You are required to give us this information on this form, in order to perform tax related functions for this office. Section 11.43 of the Tax
Code authorizes this office to request this information to determine tax compliance.
Step 1. Name and Address of Organization
Name of Organization
Present Mailing Address (number and street)
City, Town or Post Office, State, ZIP Code Phone(area code and number)
Name of Person Preparing this Application Driver's License, Personal I.D., Certificate, or Title
Social Security Number*
Organization is operated by: (please check) Individual Association Corporation
1. If operated by a corporation, is the corporation organized under Article 1434a, Tex. Rev. Civ., Stat.?
year
1. Yes No
Step 2. Answer These Questions About the Organization
3. Yes No
4. Yes No
If this application is for an exemption from ad valorem taxation of property owned by a charitable organization with a federal tax identification
number, that number may be provided here in lieu of a driver's license number, personal identification certificate number, or social security
number: ...............................
* Unless the applicant is a charitable organization with a federal tax identification number, the applicant's driver's license number, personal
identification certifcate number, or social security account number is required. Pursuant to Tax Code Section 11.48(a), a driver's license
number, personal identification certificate number, or social security account number provided in an application for an exemption filed with a
chief appraiser is confidential and not open to public inspection. The information may not be disclosed to anyone other than an employee of
the appraisal office who appraises property, except as authorized by Tax Code Section 11.48(b). If the applicant is a charitable organization
with a federal tax identification number, the applicant may provide the organization's federal tax identification number in lieu of a driver's
license number, personal identification certificate number, or social security account number.
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