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TO BE FILED WITH Exemption Application FORM <br /> Yau�s forTax Exemptian on Real and Personal Property by Glualifying Organizations 451 <br /> COUNTY ASS�S50R Read instructions on reverse side. <br /> Failure to properly complete or file this a lication'n�timely manner shall result in a disapproval^of the exemption.m��� <br /> � � � pu�ty � County No.� ^Type of Ownership <br /> � Nonprofit Corporation <br /> ` Other(Specify) <br /> Str et ar Othe ' g re � State Where Incorporated ❑ � � � � <br /> • `...? — <br /> . —_. - _.._._ .._. __._.,,...._. <br /> City Zi C Ac�ual Valuer P r el or L a ID Nu er <br /> _...�. .�� `-'�� <br /> Legal es ri i of rea ro t n eTal escri t f a i I so pe <br /> ;eXC I e 5 r v hicle <br /> 1� , (�, _� .e� <br /> . <br /> _ , <br /> 7itle af Officers, —_J T- � <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> Properry described above is used in the lollowing exempt category(please mark the applicable boxes): � m <br /> � Agricultural/Horticultural5ociety" ❑ Educativnal ❑ Religious ❑ Charitable � Cemetery <br /> —w � _.r <br /> Give a detailed description of the use of the property: <br /> 'Agricultural/Horticultural Saciety does not need to complete the following questions. � �� �� <br /> Is all oi 1he property used exclusively as described above? ❑YES ❑ Np <br /> Is a portion oi the property used tor the sale of alcoholic beverages? ❑YES ❑ NO If Yes,state the number oi hours per week <br /> Is the property owned or used by an organization which discriminates in <br /> membership or employment based on race,color,or national origin? ❑YES ❑NO <br /> Under penalties of law,I declare that I have examined this exemption application and,to lhe best of my knowledge and 6elief,it is correct and <br /> complete.I also declare that I am duly authorized to sign ihis exemption application. <br /> sign � �,_ �O�s� � � T <br /> here Au orized Signature Title Date <br /> �� FOR COUNTY ASSESSOR'S RECOMM�N�ATION �V�^T _,_,��__...___ <br /> ��APPROVAL GOMMENTS: �� ��` �._��'1����„ r�•C�-) ..____.......__....__ <br /> ��,,, � <br /> ❑ APPROVAL OF A PQFi710N .._.._,_..__...r ____.....T....... <br /> � _.._� <br /> � �,, �a <br /> ❑ DISAPPROVAL r �-!� '" `_,..._ � �`�"����� <br /> Signature qf C n y Assessor �ate <br /> �m � µ FOR COUNTY BOARb EQUALIZATION USE ONI.Y � <br /> I declare that,to the best of my knowledge and belief,the determina on hereby made by the County Board ot Equalization is correct pursuant <br /> to the laws of the State of Nebraska. <br /> � APPROVED COMMENTS: � ` W�_ <br /> ❑ APPROVAL OF A PORTION <br /> ❑ �ISAPF'ROVED � � � <br /> ignature ot County Bo e er Pate <br /> Nebraska Department of Revenue A��horiz¢d by No6.Rev.Sta�.§7J-`L02.01 <br /> 96-735-199�J Rev.7-2010 Supersodes 96-135-1999 Rev.17-2008 <br /> PLEASE MAKE A COPY FOR YOUR REGQRDS <br />