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Construction Excise Tax Exemption Application
Exemption Description (check applicable exemption):
1. Private School Improvements.
2. Public Improvements as defined in ORS 279A.010.
3. Residential housing that is guaranteed to be affordable, under
Guidelines established by the United States Department of Housing
and Urban Development, to households that earn no more than 80%
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.
5. improvements to religious facilities primarily used for worship or
education associated with worship.
6. Agricultural buildings as defined in ORS 455.315(2)(a).
Application for any of the above exemptions proves consent for the District to audit the
applicant's records to verify the legal status 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.
Authorized Signature Title
Jurisdiction Issuing Permit: d1 Permit No. ??Di1—W 1
School District in which Construction is Planned: T{Iq>< -- --c,g,gfin
Address of Construction for which Exemption is Claimed: •
Sw t l T ll of—, 111-
Permit Holder: l )tIL1l1QWIl- _ .eo athJe
Permit Holder Address: 1 o Br2 2 2,062
Permit Holder Phone: 'ji 'S `ittaPermit Holder E-Mail:e^),s`7_{.J Q4 ER,`0./t 14C . .