Report (3) SUP20Z2—oot,i
cob W U k TCN ST
AUK
Construction Excise Tax RECEIVED %%
Exemption Certificate Application
AUG 3 2023 Metro
Exemption Description(check applicable exemption) CITY OF TIGARD
1.The person liable for the tax is exempt from federal income tax;and the coaiiiiiHhiGiDaWfahicome residential housing.
The Person who would be liable for the tax is a corporation exempt from federal income taxation pursuant
/ to 42 U.S.C.501(c)(3),or a limited partnership the sole general partner of which is a corporation exempt from
v federal income taxation pursuant to 42 U.S.0 501(c)(3),the Construction is used for residential purposes and
the property is restricted to being occupied by Persons with incomes less than 60 percent(60%)of the median
income for a period of 30 years or longer;
la. Partial Applicability of Exemption(estimate percentage exempt) Percentage Exempt 100
Required Documentation(to be provided to Metro or available to Metro for review)
IRS tax status determination letter evidencing that the Person seeking the building permit is exempt from
federal income taxation pursuant to 42 U.S.C.501(c)(3).
In the case of a limited partnership with a tax-exempt sole general partner corporation,verification from the
partnership's attorney of that status.
Proof that the construction will be restricted to low income persons,as defined in 1 above,for at least 30
years.Proof can be in the form of loan covenants;rental agreements;grant restrictions;certification from
Corporate Officer attesting that exemption is applicable;or other information that may allow the exemption
determination to be made.
2.The Person liable for the tax is exempt from federal income tax;and the construction will provide charitable services
to low Income persons.
The Person who would be liable for the tax is exempt from federal income taxation pursuant to 42 U.S.C.501(c)
(3)and the Construction is dedicated for use for the purpose of providing charitable services to disadvantaged
people.
2a Partial Applicability of Exemption(estimate percentage exempt) Percentage Exempt
Required Documentation(to be provided to Metro or available to Metro for review)
IRS tax status determination letter evidencing that the Person seeking the building permit is exempt from
federal income taxation pursuant to 42 U.S.C.501(c)(3)
In the case of a limited partnership with a tax-exempt sole general partner corporation,verification from the
partnership's attorney of that status.
Proof that the construction will be used for charitable purposes as defined in 2 above.Proof can be in the
form of loan covenants;rental agreements;grant restrictions;certification from Corporate Officer attesting
that exemption is applicable;or other information that may allow the exemption determination to be made.
Application for any of the above exemptions provides consent for Metro to audit the applicant's records to
verify the legaistatus and compliance with the exemption prerequisites
I do hereby certify that by signing I am verifying eligibility for the above Exemption to the Construction Excise Tax.
094/A anL emuut. Project Manager
Authorized Signature Title
Jurisdiction Issuing Permit: City of Tigard Permit No. BUP2022-00177
Address of Construction for which Exemption is Claimed: 6835 SW Clinton Street, Tigard OR 9722:
Permit Holder: REACH CDC
Permit Holder Address: 4150 S Moody Ave, Portland OR 97239
Permit Holder Phone 323-547-9634
Permit Holder E-Mail aaleman@reachcdc.org
Construction Excise Tax Exemption Application
Exemption Description (check applicable exemption): RECEIVED
1. Private School Improvements. Au6 8 2013 0
2. Public Improvements as defined in ORS 279A.010 CITY OF TIGARD Q
BUILDING DIVISION
3. Residential housing that is guaranteed to be affordable,under guidelines 0
Established by the United States Department of Housing and Urban
Development, to households that earn no more than 80%0 of the median
Household income for the area in which the construction tax is imposed,
for a period of at least 60 years following the date of construction of the
residential housing.
4. Public or Private hospital improvements. 0
5. Non-profit long term care facilities; non-profit residential care facilities; or 0
non-profit continuing care retirement communities.
6. Improvements to religious facilities primarily used for worship or 0
education associated with worship.
7. Agricultural buildings as defined in ORS 455.315(2)(a).
Application for any of the above exemptions provides consent for the District to audit the
applicant's records to verify the legal statues and compliance with the exemption prerequisites.
I do hereby certify that by signing I am verifying eligibility for the above Exemption to the
Construction" Excise Tax.
GtAaetj t,, l egmt te, Project Manager
Authorized Signature Title
Jurisdiction Issuing Permit: City of Tigard Permit No. BUP2022-00177
School District in which Construction is Planned:Tigard Tualatin School District
Address of Construction for which Exemption is Claimed:
6835 Sw Clinton Street,Tigard OR 97223
Permit Holder: REACH CDC _._.
323-547-9634 aaleman@reachcdc.org
Permit Holder Phony:: Permit Holder E-Mail:
('ET Exemption Application 1/13/2010