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Affidavit For Exemptions


    This affidavit is to be used by organizations seeking property tax exemption pursuant to Section 170 of the Kentucky Constitution. Answer all questions as fully as possible.

  2. This affidavit is to become an integral part of the Application for Exemption from Property Taxation currently on file with the Kenton PVA office and to be used only for those entities seeking exemption on additional property(ies) originally not included and approved as part of the entity’s application for exemption.
  3. Enter Exact Legal Name of Organization
  4. Number and Street
  5. as it is printed on your tax bill (e.g. 001-01-23-456.78)
  6. Indicate whether any rents or income is received for this property and if so, the amount(s).
  7. Petitioner's Agreement to Authorization of Inspection and Affidavit of Authority:*
    For this property tax exemption application, I authorize the Department of Revenue (DOR) or its representative(s) to visit and inspect the property to be exempted now and in the future, to ensure the property is being used for tax exempt purposes. I hereby certify that the statements and information contained herein are correct to the best of my knowledge and belief and that I am authorized to sign this application. All other information submitted as part of the original application that would impact the PVA’s or Department of Revenue’s decision in granting exemption remain the same.
  8. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  9. Applicant Authorization and Signature
  10. Property Valuation Administrator / Deputy

  11. Leave This Blank:

  12. This field is not part of the form submission.