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�� O BE FIL�D WITM Exemption Application �oaM YOUR forTax Exemption on Real and Personal Prvperty by Dualifying Organizations A�� C SSESSOR Read instructions on reverse side. �t Failure ta properly complete or file this application in a timefy manner shall result in a disapproval of the exemption. � me of Orga zation County County No. Type af Qwnership NEBRP.SKA ASSOCIATION FOR DEVELOPMENTAL HOUSING HALL 40 � Nonprofit Gorporation Street or Other Mailing Address State Where Incorporated � Other(Specify) 216 N D�NVER NEBRASKA City State Zip Code Actual Value Parcel or Location ID Number WASTWGS NE 68901 $122,738 400Q77930 Legal description of real property and general description of all tangi6le personal property,except licensed motor vehicles: PLEASANT HILL ADD LOTS 25 & 26 (707 E 11TH) Title of Officers, Name Directors,or Partners Address,City,State,Zip Code IVAN KLEIN CHAIRMAN PO BOX 134 GIBBpN NE 68840 ARNOLD BROWN VICE-CHAIRMAN 3807 Ra R NEL50N NE 68961 ALLEN ETAK 5EC/'T'REAS 2017 K STREET pRD NE 68862 pIANE CAMPBELL CEO 216 N DENVER HASTINGS NE 68901 Property described above is usad in the following exempt category(please mark the applicable boxes): �Agricultural/Horticultural Society' Q Educational �Raligibus �Gharitahle �Cemetery Give a detailed description of the use of the property: To provide training and housing for developmentatly disabled citizens. They are trained and educated in cammunity living by developing self-care and housekeeping skills. 'Agricultural/Horticultural 5ociery does not need to camplete the follvwing questions. �s all of the property ussd exclusively ss described ahove? ){YES �NO Is a portion of the prpperty used for the sale of alcoholic beverages? �YES �NO If Yes,state the number of hours per week Is the prqperty owned or used 6y an organization which discriminates in membership or employment based on race,color,or national origin? �YES ❑X NO Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and betief,it is corract and complete.I also declare that I am duly authorized to sign this exemption application. $�(�n ��','�`�'"' /"�-- Chief Executive Officer �oZ.��y�� here Authorized Signature 7itle Date FOR CQUNTY ASSES50R'S RECOMMEN�ATION APPROVAL COMMENTS' � � �„�,�r� �— �� _ _ � ❑ APPROVAL OF A POFtTIDN ❑ DISAPPROVAL �� 4^ �-� Signaturq County Assessor pate FOR COUNTY BOA OF EQUALI�ATION USE ONLY I declare that,to the best of my knowledye and beliet,the determination hereby made 6y the County 6oard oi Equalization is correct pursu2nt to the laws of the 54ate of Nebraska. �, r�., �, �--`� � � ^F "a �APPROVED G�MMENTS: ��.z�� r� � , �_�� F. ❑ APPROVAL OF A PpFiT10N " �u�I ❑ DISAPPROVED � I`�ti� �°v�7G:��4"t J �� /�- Signature Of C oard ember I }��,q��],�� �Nebraske DeparUnent of Revenua • Authori�d by Na6.Rev.Stat.§77•202.01 8Fr�3�1999 Rev.7-2tl10 Supersedec 96-135-7999 Rev.11-20D8 PLEASE MAKE A COPY FOR YOUR RECORDS