Fillable Form 5: BRIANA JOHNSON Clark County Assessor (Clark County Nevada)

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Form 5: BRIANA JOHNSON Clark County Assessor (Clark County Nevada)

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BRIANA JOHNSON
Clark County Assessor
5
00 S. GRAND CENTRAL PKY. * PO BOX 551401
LAS VEGAS, NEVADA 89155-1401
APPLICATION & QUESTIONNAIRE FOR PROPERTY TAX EXEMPTION
COVERSHEET
Please complete and return the application with all supporting documentation. Once we receive
this information, we will proceed with the review process to determine if your organization may
qualify for tax-exempt status.
Nevada Revised Statutes provides for a property tax exemption on property owned and used
solely for the organization’s purpose. Not all non-profit organizations qualify for property tax
exempt status as statutory requirements vary according to the type of exemption being applied for.
Please note: The application cannot be processed until a completed and signed application is
received along with all necessary documentation. After 90 days, incomplete applications will be
closed and will need to be re-submitted with all required documentation for review.
The deadline to file a property tax exemption for real property is June 15
th
, for the upcoming
fiscal year beginning July 1
st
. If you are applying after June 15
th
, your exemption will only be
reviewed for the upcoming fiscal year unless you specifically request a review for the current
fiscal year.
If you have any questions, please contact a special project representative at (702) 455-3882.
BRIANA JOHNSON
Clark County Assessor
500 S. GRAND CENTRAL PKY. * PO BOX 551401 LAS
VEGAS, NEVADA 89155-1401 APPLICATION &
QUESTIONNAIRE FOR PROPERTY TAX
EXEMPTION
(Page 1 of 2)
NO
YES
APPLICATION FOR FISCAL YEAR: ___________________________________
(Deadline to file is June 15
th
prior to the start of the fiscal year per NRS 361.155)
NA
ME OF ORGANIZATION: __________________________________________________________________________
(Please Print)
CONTACT NAME: ____________________________ EMAIL ADDRESS: _____________________________________
CONTACT PHONE: ____________________________ BUSINESS PHONE: _____________________________________
MAILING ADDRESS: _________________________________________________________________________________
CITY/STATE ZIP
LOCATION ADDRESS: ________________________________________________________________________________
(IF THERE ARE MULTIPLE LOCATION ADDRESSES, PLEASE ATTACH AN ADDITIONAL SHEET) CITY/STATE ZIP
ARE YOU CLAIMING EXEMPTION FOR: (CHECK ALL THAT APPLY)
RE
AL PROPERTY ASSESSOR’S PARCEL NUMBER:
PERSONAL PROPERTY ASSESSOR’S ID NUMBER:
DO YOU CURRENTLY HAVE AN EXEMPTION ON ANY OTHER PROPERTY?
(If YES, please list Parcel or Assessor ID numbers)
1.
P
ursuant to Nevada Revised Statutes, what type of Exemption is being applied for? Please check applicable Statute(s)
listed below.
Charter Schools NRS 361.065
Water Users NRS 361.073
C
are of Orphans or Indigent NRS 361.083
Housing for Elderly or Handicapped NRS 361.086
Veteran’s Organization NRS 361.095
Leasing to a Charter School NRS 361.096
University Charitable Foundation NRS 361.098
University Fraternity / Sorority NRS 361.100
Non-Profit Private School NRS 361.105
Certain Apprenticeship Programs NRS 361.106
Specific Organization NRS 361.110
Church, Chapel Property NRS 361.125
Lodges / Charitable Organization NRS 361.135
Religious, Educational, Charitable Corporation NRS 361.140
Other (Please List NRS) ____________________________________
2. If your organization is applying for an exemption pursuant to NRS 361.065 or 361.096, please include a copy of the
Charter School Agreement and a complete copy of any Lease Agreement.
3. If your organization is a church or religious society, please answer the following:
Number of members? _________________ How often does your church hold services? _______________________
Name of church Clergyman? _______________________________________________________________________
In what church has your Clergyman been ordained? _____________________________________________________
Does your organization have functions in addition to those of a religious nature: YES NO
If yes, type of functions? ___________________________________________________________________________
BRIANA JOHNSON
Clark County Assessor
500 S. GRAND CENTRAL PKY. * PO BOX 551401 LAS
VEGAS, NEVADA 89155-1401 APPLICATION &
QUESTIONNAIRE FOR PROPERTY TAX
EXEMPTION
(Page 2 of 2)
4. If your organization is not a church or a religious society, does it provide medical care to people who are not able to pay?
YES NO
5. Is your organization a corporation or affiliated with a corporation?
YES Please attach copy of Corporate Articles, Bylaws, State Charter and current Annual Financial Statement.
NO Please furnish copy of current Annual Financial Statement.
ALL DOCUMENT FURNISHED MUST BE COMPLETE WITH SIGNATURES, DATES AND ENDORSED
BY THE APPRORIATE AGENCY.
6. State the purpose of your organization: ________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
7. What are the sources of income for your organization?
Government Grants Percentage of total income ______________________________
Donation Percentage of total income ______________________________
Sales of any kind Percentage of total income ______________________________
Services Percentage of total income ______________________________
Other Percentage of total income ______________________________
(
THIS AREA MUST CORRESPOND WITH YOUR FINANCIAL STATEMENT)
8. For what purpose is the income of the organization used? _________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
9. Do you own or rent / lease your present location? Own Rent / Lease
IF YOU ARE RENTING / LEASING, PLEASE SUBMIT A COPY OF RENTAL OR LEASE AGREEMENT.
10. Who is the owner of record and / or legal owner of the real property on which an exemption is requested?
______________________________________________________________________________________________
11. Are there any contracts that will affect the future ownership of the above real property? YES NO
IF YES, PLEASE ATTACH A COPY OF THE DOCUMENTATION
12. Is all or any part of the real property or personal property leased, rented or used by anyone other than your organization:
YES NO IF YES, PLEASE SUBMIT NAME, ADDRESS, TELEPHONE NUMBER AND A COPY OF
THE LEASE OR RENTAL AGREEMENT.
13. Please attach any other documents you rely upon in support of your claim for exemption and explain their
significance. ____________________________________________________________________________________
I HEREBY ATTEST UNDER PENALTY OF PERJURY THAT THE ANSWERS GIVEN ABOVE ARE TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
SIGNED: ______________________________________
TITLE: ______________________________________
DATE: ______________________________________
ASSESSOR’S USE ONLY:
Date Issued: ___________________
Date Received: _________________
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Form 5: BRIANA JOHNSON Clark County Assessor (Clark County Nevada)

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Completed 19 April 2022

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