APPLICATION FOR PERSONAL PROPERTY TAX EXEMPTION FOR THE YEAR _______________ (FILL IN YEAR YOU ARE APPLYING FOR)

Name of the Organization: _____________________________________________________ Jackson County Business Personal Property Account Number ________________________ Mailing Address:

City:

____________________________________________________________

State:

Office Phone #

Zip: ____________

Alternate Phone #_______________________

D.B.A. (If different from corporate name) _________________________________________

ADDRESS WHERE PERSONAL PROPERTY IS LOCATED (if different from mailing) Street

City

State ______

Date your organization began activities at this location: 1.

Day

___ Mo __

Yr

Type of organization (e.g., church, school, civic, social, fraternal, educational, etc.

_____________________________________________________________________________

2.

Purpose of Organization: _________________________________________________

______________________________________________________________________________

3.

Is the Organization not-for-profit?

Yes

No___________

4.

Describe the activities of the organization: ___________________________________

______________________________________________________________________________

Page 2.

5.

Source(s) of income for the organization: ____________________________________

______________________________________________________________________________ 6.

For what is the income used? ______________________________________________

______________________________________________________________________________ 7.

List the furniture, fixtures and equipment which you own, and are seeking exemption for (attach additional sheet if necessary): (FF & EQ that does not qualify for tax exemption will be taxed on Jackson County’s Personal Property Business tax rolls.) _______________________________________________________________

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 8.

How is the above listed personal property used in the organization’s operation?

____________________________________________________________________________ _____________________________________________________________________________ 9.

Are you requesting exemption on vehicles? Yes

No___________

If you answered yes to the above question, complete attachment “B”. This form must be completed in its entirety. Vehicles that do not qualify for tax exemption will be taxed on Jackson County’s Personal Property Business tax rolls. Vehicle exemption will be reviewed each year for exemption qualifications.

10.

Does your organization lease any personal property? Yes

No_________

If you answered yes to the above question, complete attachment “A”.

Page 3.

11.

Do you own the real-estate where you operate this business? Yes

No_______

If you answered yes to the above question answer the following. A. The parcel number or legal description is:

______________________________________________________________________________

B. Is this property exempt from real-estate taxes? Yes

_

No_________

C. In what name is the deed recorded? _______________________________

12.

Is there any other organization or business at this same location? Yes

No_____

If you answered yes to the above question please supply (on an attached sheet): A. Name(s) of the other business. B. Affiliation they have to your organization.

13.

Is any part of the property used as a residence? Yes

No_______

If you answered yes to the above question, please give: A. Resident(s) connection with the organization. B. Duties of the resident(s) in connection with the property.

14.

Have you applied for tax exemption on this personal property previously? Yes No_____

If you answered yes to the above question, give an explanation for this application. Such as a change in use, name change, additional information, etc. _______________________________________________________________________

_______________________________________________________________________

Page 4.

15.

The applicant must submit the following documents: A. B. C. D.

A copy of the Articles of Incorporation. A copy of the organizations constitution, regulations or by-laws. A list of all officers, directors, trustees, shareholders, etc. of organization. An income and expense statement of the organization for the current and preceding year.

. RETURN TO JACKSON COUNT ASSESSMENT DEPARTMENT Historic Truman Courthouse 112 W. Lexington, Suite 144 Independence, MO 64050 ATTN: EXEMPTIONS - BPP REFERENCE FOR EXEMPTIONS SECTION 137.100 AND 137.101, RSMO. ARTICLE X, SECTION 6, MO CONST. AND APPLICABLE CASE LAW. The undersigned declares that all of the statements and representations in this application are with his personal knowledge and are true. Note: Pursuant to state statute 575.050 and 575.060 RSMO., making a false affidavit or a false declaration is a misdemeanor and subject to criminal punishment. Applicant or representative (printed) _____________________________________________

Applicant or representative signature _____________________________________________ Date _____________

Title ________________________________________

Subscribed and sworn to before me this

Day of

, 20 ____

My commission expires (Notary Seal)

.

"A" ATTACHMENT LEASED EQUIPMENT

NAME & ADDRESS OF LESSOR

QUALITY & DATE OF DESCRIPTION ACQUISITION

TERM OF LEASE

YOUR COST PER MONTH

“B” LIST ALL VEHICLES OWNED

EXEMPTION REQUEST FORM

RETURN WITH APPLICATION ONLY VEHICLES DEDICATED

Principal Driver Information

TO YOUR NON-FOR-PROFIT USE MAY QUALIFY FOR TAX EXEMPTION COMPLETE ALL SECTIONS DRIVER %

AUTOMOBILES

Make

Model

Series

Year

VIN#

Name on Title

Date

Use of

Acquired

Vehicle

Name

Address

Home

Position

Personal

Vehicle

#of miles Reported

Address

w/ Org

Use

Parked

to IRS

Trucks

Trailers

NAME OF ORGANIZATION: ACT.# (IF ASSIGNED) ADDRESS: City, State, Zip:

RETURN TO : JACKSON COUNTY ASSESSMENT DEPT - BPP Historic Truman Courthouse 112 West Lexington Ste 144 INDEPENDENCE, MO 64050 ADLT SPACE FOR YOUR USE OR ATTACH ADLT SHEET.

TELE # 881-4672