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TO BE FILED WITH Exemption Appl ication �o�M YOUR forTax �xemption on Real and Personal Property by Qualifying Organizations COUNTY ASSESSOR Read instruczions on reverse side. �� Failure to properly complete or file this application in a timely manner shall result in a disapproval af the exemption.�� Name f n ' County � j�,, Co y No. Type of Ownership ° � �1��l t 1 � Nonprofit Gorporation Str or Othe aili Address State Where Incorporated � Other(Specity) �1 �'=�..�� � S t e Actual V . . �'ar e or ti I ___�� l.__. _. ----- ._. ._. � L I cription of real property and eral descriptiqn of all ta ible personal property,except licensed ot r vehicles: � Title of pfficers, �f Name Directors,or Partners Address,City,State,Zip Code _ ... � � _._.._._...,..._......_..---T._..—._..._...._._._ Property described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural/Horticultural Society' � Educational ❑ Religious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property; T "Agricultural/Horticultural Society does not need to complete the following questions. ^ Is all of the property used exclusively as described above? ❑YES ❑ NO Is a portion oi the property used tor the sale oi alcoholic beverages? ❑YES ❑ NO If Yes,state the number of hours per week_.__,.�,_.___._._._._.__.__�..___.�.�� Is the property owned or used by an organization which discriminates in membership or employment based on race,color,or national origin? ❑Y�5 ❑NO _ �� Under penalties of law,I declare that I have examined this exemption application and,to ihe best of my knowledge and beliet,it is correct and � � completa.I also declare that I am duly authorized to sign this exemption application. S� tl y �tCSJ/� _/ r�^ � /.3 Z�I� 9 ��-� ;,�� ,. _. _ _._ ..... �_ _____._.. here �uth�gnature 7itle Da FQR COUNTY ASSESSOR'S RECOMMENI]A710N �APPROVAL COMMENTS: ��-_ �t�r�---- .___,..._. ❑ APPROVAL OF A PORTIQN ,, ..__.W_.._..._.__..._.....�..�___.__...,,... , 1 � �,, tr�� � (�ISAPPROVAL `� __. ` Signature o C nty Assessor Uate � _ � �� FOR COUN7Y 9QARD EQUALIZATION USE ONLY �_..n..�_ I declare that,to lhe best pf my knowledge and beliei,the determination hereby made by the County eoard ot Equalization is correct pursuant to the laws of the State of Nebraska. uAPPROVED COMMENTS: _ �w.N.^^y�� TT rv. .w ❑ APPRDVAL OF A PORTION _ �_ ❑ �ISAPPROVED � gnature of County Bo em r D e Nebraska�epartment of Hevenue Authorized 6y Neb.Rev.Stat.§77-202.01 96-135-1999 Rev.7-2010 Supersede&96•135-1999 Rev.11-2008 PLEAS�MAKE A COPY FOR YOUR RECORDS