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� 2012 <br /> T � ���p W��� Exennp#ic�r� App(i����c�r� �o�� <br /> Y°u�a farTax Ex�mptian on i�eal and Personal Property by c�ualiiying Organizaiions ��� <br /> C 1`Y A5SE550R Read instructions on reverse side_ <br /> � Faikure te prnperfy complete or tile this application in a timely manner shali resulE ir�a disappravaE of the exemption. <br /> hame of Orgar,ization County Gcuny fVa. Type ot O�Nr:ership - <br /> MID-PLAINS CENT�R-BEHAV H�ALTHCAR� I°lall �}p � �a�nprotit Gorppratior, <br /> Streei or O[F�ar h9ai!ir�ry Addrr�=s State Nfiare Ircorrinry?ed � Othar lSpeci4yl <br /> 615 N ELM N�BRASKA <br /> �ity Stato i ip Cnda Actuai Value Purcel or Lacatipr ld Nurnh�r <br /> GRAND ISLAND NE 68801 418,128 4000D0849 <br /> Legal descripticn o`:real property and genera;description nt all tangible personal p!op�K;d,ex��ept licensed moior veh�cies: <br /> ORIGINAL TOWN LTS 3-4-5 BLK 11 (519-523 W 77H) <br /> Tit1e af Officers, <br /> ���� Directors;ar Partners Addrsss,Gity,5tate,Zip Code <br /> �_.�.�.__. _.W�_ -------------�---°--------�•••---- ---•••••_-----•----- •• ••- �.�.7•••---------------��-�-.•••-•-_ <br /> rr � �i'G5ilk�li d- G U ��0�� �/►�i2n���Dr.�Gr�snt��3�G-c'C0���'L �n��� <br /> ae-) 7 u�c�.�r 'c�cWrF CFU �3 f,�• iar`S',1�+- � a Zh��•,d NL 66 <br /> grcL .e ' ice_ ��de�tt Par�x 7(a /a. Al� b cZ �._ <br /> L7P�t('a �Er-i�Pf"3-_.J��-�"- - �'1?d_ �CJ"1`_ ... _.""""-' _�.'-"._._.� .""'-" ...."""""'.--- -------_.-"."'.'-'__' <br /> Prepe�ty descrii�ad nbrN�is�isad in the foAowin�e.xernpt categnry(piease rnyrk the ap�lica�la bexrsj: � <br /> ❑A rc�IturaiiFicr:icuHural Soc�ety" � Educa4io�ial �Rsfigious �Charit=_ble �Ce"netery <br /> �� . <br /> Giv�a datai!ed descr:ption of he use of ih�prepe;ty: �fcpF�}.� ;5�ec� �a �;a M�.S�' �•��7r' �'��=0�"w� 1������`° .�t�✓Le�� ���PcCu�� <br /> '��.c�v�nt.��5� Co�ti"} arde�� V.di-�af�rn�i� cind vf'�,er �PqP��iF[. Ser��ce5 T�4a�57� b'-'� 111� {�J�S�h'��"��id � •5nc� � <br /> ✓s��c L�h�w�i1'w� NEAIT�iCatrt .S�S'(-'fN-�, V <br /> "AgriculTural/Horticultural Soci�ty daes hot need to compiete ihe f�iluwing questions. <br /> Is all oi the proparty used exc�usively�s dessribed abova7 �YES �NO <br /> Is�partinr of the ptctae!'ty uved ior itie saie at elcohuiic bevereges7 �YrS �NO 11 Yc;s,siaiP the nurn6e>r�?hours.per week � <br /> Is the prop�rty awned or used hy an organization which discr!mir,ates i� <br /> mmmbership or employment busod on race,color,er nationa!orip'n? �Y�S �NO <br /> Under penalties cf 13sv,I dadare that I have examined this exempti�n appiication and,to the Gest ot my znowiedge ard Coliet;it is cnrrect and <br /> cexn��iete.I aiso dec:IHre that i am c;uly authr,rized ta sign lhis exernjitlon applicatiq7. <br /> S�C,��'1 `�� / //�-�f+ <br /> �-y�8r� �Au:hori d Signatur Title Date <br /> �ii <br /> ---------__-__—_._.. --•-- ----------_._•••�•---- --•.W_••-�_--- •••.• �-�-__•••���� --°-•-•••-••-..,�_.,-------- — <br /> FDR GDl1tdTY AS5ESSOR'S RECOMMEN[1A71DN <br /> A?WHOV!�L COMM���TS: ��.✓n .n�Jl� �Z` �L U , ---- - <br /> � <br /> �,,; A?PROVAL OF A P(7RTlC�N <br /> ❑ ❑ISAPrR�VAI � 1~ ��y `� <br /> SiGnature i G un •Assessor p�tN <br /> -------------._•__ F�R CO '.._.'..-- - -•..._�•-••••._.--------------••••••--------------�-•.•-•-.•-•-••---------------•---.•-•-••.••-••••••.._.-----� <br /> ._.�^�•••.--�•�- UNTY BQ/SR F EQUALIZATIQN USE pNLY <br /> 1 f � I der,lare ihat,ta the he5t uf m rcnnw,sdr a and u <br /> � y �, eliel,ihe detsrminat on herehy r+ade 6y;he County Poard r�t Fyuali�,ation is n:rrect pursuant <br /> to the lav's of the Stata of Nebraska. <br /> � APPHOVED COM'JlEN75: <br /> Li A?PRJVP.L.pF A PCJFi710N •_------�-•••••-•• ----- -�_. �..--°--•••��•--.��� ...•_•-••••-,------------�-�-•••••---•------------- <br /> ❑ QISAPPRGV�n ,4`� ��f� <br /> .iynar,ur nurty �ar er � <br /> �. �oa.o= <br /> Vahrasks Gnpar;ment uf�ev^nue <br /> 36-135•7989 ReV.7-2P1�5upersedes 96-135-�999 Hev.11•?fJOe <br /> Nav 2 8 zo�1 <br /> PL�ASE MAK�A COPY FOR YOUF� RECt�R�S <br /> HALL CQUN7Y ASSESSOR <br /> GRANQISLAND,NEBRASKA <br />