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,� �F��E WITH Exemption Application FORM <br /> You fpr7ax Exemption on Real and Personal Praperty by Qualifying Organizations <br /> N ES50R 451 <br /> Read instructions on reverse side. <br /> Failure to properly complete or file this application in a timely manner shali result in a disapproval of the exemptivn. <br /> Name bf Organizatibn CounTy County Np. Type bf Ownership <br /> MID-NEBR,QSKA FOUN�ATION, INC HALL 4D � NonprofitCorporation <br /> Street pr Other Maiiing Address State Where Incorporated � Other(Specify) <br /> 216 N 17ENVER NEBRASKA <br /> C�ty State Zip Code Actual Value Parcel or Location I�Numt�er <br /> HASTINGS NE 689�1 $1,366,665 <br /> Legal descripYion of reai property and general description of all tangihle personal property,except licensed motor vehicles: <br /> EVANS Apq LT 1 &E1/2 LT 2 BLK 13 (1021 E 5TH) (4 PLEX)#4p0128810 <br /> �VANS ADD W 1/2 LT 2�.ALL LT 3 BLK 13 (1091 W 5TH) (4 PLEX)#400128829 <br /> BOSSELMANS 2ND 5UB LTS 13 & 14 (2536 N CARL�70N)#400023458 <br /> Title of Officers, <br /> Name Directars,or Partnars Address,City,State,Zip Code <br /> IVAN KLEIN CHAIRMAN PO BOX 134 GIBBON NE B884p <br /> AF2NOLb BROWN VICE-CHAIRMAN 3807 RD R, NELSON NE 68961 <br /> ALLEN CETAK SEG/TREAS 2017 K STREET ORD NE 68862 <br /> DIANE CAMPBELL CEO 216 N bENVER HASTINGS NE 68901 <br /> Propetty descrihed above is used in the following exempt category(please mark the applicable boxes): <br /> �Agricultural/Horticultural Society" � Educational �Religious �Charitaple �Cemetsry <br /> Give a detailsd description ot the u5e of the property: <br /> To provide training and housing for developmentally disabled citizens. They are trained and educated in <br /> cammunity living by developing self-care and housekeeping skills. <br /> "AgriculturaVHorticultural 5ociery does not need to complete the following questions. <br /> is all of the property used exclusively as described above? �YES �ND <br /> Is a portion of the property used for the sale of alcohvlic beverages? �YES �X NO If Yes,srate the number of hours per week <br /> !s the property ownad br used by an organization which discriminates in <br /> membership or employment based on race,color,or national origin7 �YES �Np <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledgs and belief,it is correct and <br /> complete.I also declare that I am duly authorized to sign this exemption application. <br /> s i g n n "J' Chief Executive Offcer �.-��`"�� <br /> here '�thorized Signature TiUe Date <br /> FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> �APPF{OVAL COMMENTS: ��� �`t���6 <br /> ❑ APPROVAL OF A PORTION <br /> ❑ DISAPPRDVAL � �-��_�'`� <br /> Signature t ounTy Assessor Date <br /> FOR CQl1NTY BQAR F EQUALfZATIpN U5E ONLY <br /> I declare that,to the best of my knvwledge and belief,the determination hereby made by the County Board of Equalization is correct pursuant <br /> to the laws of the State of Nebraska. <br /> APpRDVED CDMMENTS: ��� ��� <br /> �' ��-����-� � <br /> ❑ APPROVAL OF A PORTIDN <br /> DE ) ) <br /> ❑ ❑ISAPPFIOVED / 'r�/`I� <br /> ignature of County oard mber ��� � �•��,,�,;i�� ������� te <br /> Nebraske Depanment of Revenue (�'� .�,_L r.(�(JI �1��� �cf�zed 6y Neb.Rev.Stflt.§77-2a2.01 <br /> 86-135-1999 Rev.7-2010 Supersedes BF 13rx1999 Fiev.17-2008 �a rl.,,�.���'-''���.. <br /> PLEASE MAKE A COPY FOR YDUR RECORDS <br />