Before me, a Notary Public, or Clerk in the License Commissioner's
Office personally appeared ,
who, being duly sworn according to law, deposes and says that he is duly
authorized by the Church, School or Organization listed below to sign this
affidavit and that all property, real and personal owned by them, is used
exclusively for religious worship, for schools, or for purposes purely
charitable and that the foregoing is true to the best of his knowledge and
belief, further affiant saith not. He is therefore making application for
exemption of ad valorem tax in the amount of on motor vehicle tag for the year
Year:
Mode l:
VIN Number:
Name of School, Association or Church
Sworn to and subscribed before me on this ____ day of _______________,
20_____.
___________________________________
Notary Public or Clerk
TG002 1/2000
