Form 50-282 "Application for Ambulatory Health Care Center Assistance Exemption" - Texas

What Is Form 50-282?

This is a legal form that was released by the Texas Comptroller of Public Accounts - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the Texas Comptroller of Public Accounts;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 50-282 by clicking the link below or browse more documents and templates provided by the Texas Comptroller of Public Accounts.

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Download Form 50-282 "Application for Ambulatory Health Care Center Assistance Exemption" - Texas

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Form
Texas Comptroller of Public Accounts
50-282
Application for Ambulatory Health Care Center
Assistance Exemption
_____________________________________________________________________
___________________________
Appraisal District’s Name
Phone (area code and number)
___________________________________________________________________________________________________
Address, City, State, ZIP Code
GENERAL INSTRUCTIONS: This application is for use in claiming a property tax exemption on property owned by an organization engaged exclusively in
providing assistance to ambulatory health care centers pursuant to Tax Code Section 11.183. This application applies to property you owned on Jan. 1 of this year.
FILING INSTRUCTIONS: You must furnish all information and documentation required by this application so that the chief appraiser is able to determine
whether the statutory qualifications for the exemption have been met. This document and all supporting documentation must be filed with the appraisal
district office in each county in which the property is located. Do not file this document with the Texas Comptroller of Public Accounts. A directory with
contact information for appraisal district offices may be found on the Comptroller’s website.
APPLICATION DEADLINES: You must file the completed application with all required documentation beginning Jan. 1 and no later than April 30 of the
year for which you are requesting an exemption.
DUTY TO NOTIFY: If the chief appraiser grants the exemption, you do not need to reapply annually, unless the chief appraiser requires it or you want the
exemption to apply to property not listed in this application. You must notify the chief appraiser in writing if and when your qualification for this exemption ends.
OTHER IMPORTANT INFORMATION
Pursuant to Tax Code Section 11.45, after considering this application and all relevant information, the chief appraiser may request additional information
from you. You must provide the additional information within 30 days of the request or the application is denied. For good cause shown, the chief appraiser
may extend the deadline for furnishing the additional information by written order for a single period not to exceed 15 days.
State the tax year for which you are applying for this exemption.
________________________________
Tax Year
STEP 1: Organization Information
___________________________________________________________________________________________________
Name of Organization
___________________________________________________________________________________________________
Mailing Address
____________________________________________________________________
____________________________
City, State, ZIP Code
Phone (area code and number)
Organization is a (check one):
________________________________________________________
Partnership
Corporation
Other (specify):
STEP 2: Applicant Information
________________________________________
__________________________
___________________________
Name of Person Preparing this Application
Title
Driver’s License, Personal I.D. Certificate
or Social Security Number*
If this application is for property owned by a charitable organization with a federal tax identification number,
that number may be provided in lieu of a driver’s license number, personal identification certificate
____________________________
number or social security number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* Pursuant to Tax Code Section 11.48(a), a driver’s license, personal I.D. certificate or social security number provided in an application for an exemption
filed with a chief appraiser is confidential and not open to public inspection. The information may not be disclosed to anyone other than an employee of
the appraisal office who appraises property except as authorized by Tax Code Section 11.48(b).
The Property Tax Assistance Division at the Texas Comptroller of Public Accounts provides property tax
For more information, visit our website:
comptroller.texas.gov/taxes/property-tax
information and resources for taxpayers, local taxing entities, appraisal districts and appraisal review boards.
50-282 • 04-17/7
Form
Texas Comptroller of Public Accounts
50-282
Application for Ambulatory Health Care Center
Assistance Exemption
_____________________________________________________________________
___________________________
Appraisal District’s Name
Phone (area code and number)
___________________________________________________________________________________________________
Address, City, State, ZIP Code
GENERAL INSTRUCTIONS: This application is for use in claiming a property tax exemption on property owned by an organization engaged exclusively in
providing assistance to ambulatory health care centers pursuant to Tax Code Section 11.183. This application applies to property you owned on Jan. 1 of this year.
FILING INSTRUCTIONS: You must furnish all information and documentation required by this application so that the chief appraiser is able to determine
whether the statutory qualifications for the exemption have been met. This document and all supporting documentation must be filed with the appraisal
district office in each county in which the property is located. Do not file this document with the Texas Comptroller of Public Accounts. A directory with
contact information for appraisal district offices may be found on the Comptroller’s website.
APPLICATION DEADLINES: You must file the completed application with all required documentation beginning Jan. 1 and no later than April 30 of the
year for which you are requesting an exemption.
DUTY TO NOTIFY: If the chief appraiser grants the exemption, you do not need to reapply annually, unless the chief appraiser requires it or you want the
exemption to apply to property not listed in this application. You must notify the chief appraiser in writing if and when your qualification for this exemption ends.
OTHER IMPORTANT INFORMATION
Pursuant to Tax Code Section 11.45, after considering this application and all relevant information, the chief appraiser may request additional information
from you. You must provide the additional information within 30 days of the request or the application is denied. For good cause shown, the chief appraiser
may extend the deadline for furnishing the additional information by written order for a single period not to exceed 15 days.
State the tax year for which you are applying for this exemption.
________________________________
Tax Year
STEP 1: Organization Information
___________________________________________________________________________________________________
Name of Organization
___________________________________________________________________________________________________
Mailing Address
____________________________________________________________________
____________________________
City, State, ZIP Code
Phone (area code and number)
Organization is a (check one):
________________________________________________________
Partnership
Corporation
Other (specify):
STEP 2: Applicant Information
________________________________________
__________________________
___________________________
Name of Person Preparing this Application
Title
Driver’s License, Personal I.D. Certificate
or Social Security Number*
If this application is for property owned by a charitable organization with a federal tax identification number,
that number may be provided in lieu of a driver’s license number, personal identification certificate
____________________________
number or social security number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* Pursuant to Tax Code Section 11.48(a), a driver’s license, personal I.D. certificate or social security number provided in an application for an exemption
filed with a chief appraiser is confidential and not open to public inspection. The information may not be disclosed to anyone other than an employee of
the appraisal office who appraises property except as authorized by Tax Code Section 11.48(b).
The Property Tax Assistance Division at the Texas Comptroller of Public Accounts provides property tax
For more information, visit our website:
comptroller.texas.gov/taxes/property-tax
information and resources for taxpayers, local taxing entities, appraisal districts and appraisal review boards.
50-282 • 04-17/7
Form
Texas Comptroller of Public Accounts
50-282
STEP 3: Property Information
Attach one Schedule A form for each parcel of real property to be exempt.
Attach one Schedule B form listing all personal property to be exempt.
STEP 4: Questions About the Organization
1. Is the association exempt from federal income taxation under Internal Revenue Code of 1986 Section 501(a), as an
organization described by Section 501(c)(3)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. In the past year has the association loaned funds to, borrowed funds from, sold property to or bought property from a
shareholder, director or member of the association or had a shareholder or member sell an interest in the association
for a profit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, attach a description of each transaction. For sales, give buyer, seller, price paid, value of the property sold and date
of sale. For loans, give lender, borrower, amount borrowed, interest rate and term of loan. Attach a copy of note, if any.
3. Does the association provide assistance to ambulatory health care centers that provide medical care to individuals without
regard to the individuals’ ability to pay, including providing policy analysis, disseminating information, conducting continuing
education, providing research, collecting and analyzing data or providing technical assistance to the health care centers? . . . . .
Yes
No
4. Is the association funded wholly or partly, or assists ambulatory health care centers that are funded wholly or partly, by a
grant under Public Health Service Act Section 330 (42 U.S.C. Section 254b) and its subsequent amendments? . . . . . . . . . . . . .
Yes
No
5. Does the association perform abortions or provide abortion referrals or provide assistance to ambulatory health care centers
that perform abortions or provide abortion referrals?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
6. Does the association perform or does its charter permit it to perform any function other than ambulatory health care center
assistance?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If yes, attach a statement describing the other functions in detail.
7. Does the organization operate in such a manner that does not result in the accrual of distributable profits, the distribution of
profits or the realization of any other form of private gain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
STEP 5: Questions About the Organization’s Bylaws or Charter
Attach a copy of the charter, bylaws or other documents adopted by the organization which govern its affairs and answer the following questions.
1. Does the organization use its assets in providing its assistance to ambulatory health care center functions or assistance
to ambulatory health care center functions of another organization?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
2. Do these documents direct that on the discontinuance of the organization, the organization’s assets are to be transferred
to the state of Texas, the United States or an educational, religious, charitable or other similar organization that is qualified
for exemption under Internal Revenue Code Section 501(c)(3), as amended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
___________
___________
If yes, provide the page and paragraph numbers.
Page
Paragraph
3. If no, do these documents direct that on discontinuance of the organization, the organization’s assets are to be transferred to
its members who have promised in their membership applications to immediately transfer them to the State of Texas, the
United States or an educational, religious, charitable or other similar organization that is qualified for exemption under
Internal Revenue Code Section 501(c)(3), as amended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
___________
___________
If yes, provide the page and paragraph numbers.
Page
Paragraph
4. If yes, was the two-step transfer required for the organization to qualify for exemption under Internal Revenue Code
Section 501(c)(3), as amended? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
5. Does the organization operate, or does its charter permit it to operate, in such a manner as to permit the accural of profits,
the distribution of profits or the realization of any other form of private gain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
STEP 6: Certification and Signature
By signing this application, you designate the property described in the attached Schedules A and B as the property against which the exemption for
ambulatory health care center assistance associations may be claimed in the appraisal district. You certify that the information provided in this application
is true and correct to the best of your knowledge and belief.
_____________________________________________________
____________________________________
Print Name
Title
_____________________________________________________
____________________________________
Authorized Signature
Date
If you make a false statement on this application, you could be found guilty of a Class A misdemeanor or a state jail felony under Penal Code
Section 37.10.
comptroller.texas.gov/taxes/property-tax
Page 2
For more information, visit our website:
50-282 • 04-17/7
Form
Texas Comptroller of Public Accounts
50-282
Schedule A: Description of Real Property
Complete one Schedule A form for each parcel of real property to be exempt. List only property owned by the organization. Attach all completed schedules
to the application for exemption.
___________________________________________________________________________________________________
Name of Property Owner
____________________________________________________________________
____________________________
Legal Description of Property (if known)
Appraisal District Account Number (if known)
___________________________________________________________________________________________________
Describe the Primary Use of the Property
________________________________
Is this property reasonably necessary for operation of the organization? . . . .
Yes
No
Date of Acquisition of the Property
List all other individuals and organizations that used this property in the past year and provide the following information for each.
NAME
DATES USED
ACTIVITY
RENT PAID, IF ANY
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Page 3
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50-282 • 04-17/7
Form
Texas Comptroller of Public Accounts
50-282
Schedule B: Description of Personal Property
Complete one Schedule B form for all personal property to be exempt. List only property owned by the organization. Continue on additional pages if
necessary. Attach completed schedule to the application for exemption.
___________________________________________________________________________________________________
Name of Property Owner
Is this property reasonably necessary for operation of the organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
ITEM
LOCATION
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Page 4
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50-282 • 04-17/7
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