permissive exemption application page | 7 city of courtenay application form: permissive exemption from property taxation pursua

permissive exemption application Page | 7

City of Courtenay
Application Form: Permissive Exemption from Property Taxation
Pursuant to Section 224 of the Community Charter
(exemption from taxation under Annual Rates Bylaw)
DECLARATION
Pursuant to Section 224 of the Community Charter:
I, of ,
Name Street Address
Telephone No. ( ) or ( )
City/Town
In the Province of British Columbia, do solemnly declare THAT:
I am the of the
Position Currently Held Within Organization
Name of Corporation, Association, Society or Organization
Have knowledge of the facts hereinafter detailed with respect to the
property/properties for which a tax exemption is being applied for.
Signature of Applicant: _____________________________________________
Date: _____________________________________________
PROPERTY INFORMATION:
Roll/Folio No. Civic Address
Legal Description of Property
________________________ ________________________
Roll/Folio No. Civic Address
Legal Description of Property
________________________ ________________________
Roll/Folio No. Civic Address
Legal Description of Property
(if there are additional properties, add additional information as
required)
ORGANIZATION INFORMATION
1.
Full name/title of organization:
2.
Mailing address of the organization (including Postal Code):
3.
Primary Contact:
Name:
Title:
Phone No.:
Email Address:
4.
Is this a Registered Non-Profit Organization?
 Yes
 No
5.
Is this a Registered Charity?
 Yes Charity Number_____________________________
 No
6.
Name and phone number of two other officials in organization (i.e.
Pastor, President, Manager, etc.)
(i) Name: (ii) Name:
Title: Title:
Phone No.: Phone No.:
Email Address: Email Address:
7.
The lands are registered in the name of:
8.
Documentation required:
a.
A copy of the Certificate of Title for first time applicants
b.
A copy of the latest yearend financial statements. For new
applicants – a copy of the last three year’s financial
statements.
c.
A copy of the budget for the current year plus one year
9.
If the premises are leased – the following is required:
a.
Copy of executed lease agreement
b.
Proof from the registered owner that the permissive exemption
received in the prior year has reduced the leasee’s share of
the annual property tax levy
USE OF PROPERTY INFORMATION
10.
The gross floor area of the building:
11.
Number of parking spaces: Gravel:
Blacktop:
Undeveloped:
12.
What is the principal use of the property?
13.
Is any part of the building or of the property used or rented by
commercial or private operators or by any group other than your
organization? If yes, provide details including percentage of
building/property allocated to this use.
14.
Does anyone live in the buildings? If yes, how many people?
15.
Square footage of living area:
16.
Has there been any change in the status or use of the buildings or
property in the last 12 months? If yes, please explain briefly.
INFORMATION ON THE SERVICES PROVIDED BY THE ORGANIZATION
11. Please provide details of other activities on your property; such
as daycare centers, catering and
hall rental, thrift shop.
The following information is required for each activity:
*
Hourly per day and/or days per week of operation
*
Fee or charges imposed on users
*
Approximate number of participants
*
Is the activity operated by the church or by an outside
organization?
12. (a) Describe your organization’s non-profit activities.
b.
Describe how your organization is accessible to the general
public. For example – is access to services restricted to members?
(c) REQUIRED: Provide usage statistics by jurisdiction.
ie. % use by City of Courtenay residents
% use by residents outside of City of Courtenay
13. Other non-profit activities or additional information which may be
pertinent to your application:
NOTES:
1.
The personal information on this form is collected for the purpose
of an operating program of the City of Courtenay as noted in
Section 26(c) of the Freedom of Information and Privacy Act. If
you have any questions about the collection and use of this
information, please contact the Director of Financial Services at
250-334-4441.
2.
Applications for Permissive Tax Exemption must be received by the
15th of JUNE in the year prior to the taxation year for which
exemption is requested, in order to be included on the applicable
annual Permissive Tax Exemption Bylaw.
3.
Permissive Tax Exemption Applications are to be submitted to:
The City of Courtenay
Attention: Director of Financial Services
City of Courtenay
830 Cliffe Avenue
Courtenay, B.C.
V9N 2J7
FORM 196001APPLICATION (revis 2014).docx Page | 7

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