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°�� 2012 <br /> �����aw�TH Ex�rr�ption Appii�atian �o�� <br /> vauA farTax Exemptian an Re�l arsd Personal Praparty hy Qualifying �rganizations 4�� <br /> � CDUN AS5ESSOFi F�ead instructians on reverse aide. <br /> Faifure ta properly camplete or fi{e this appiication in a timely manner shaiE re5ull in a disapapravai ot the�xemption. <br /> � J�ame of rgar.ization Counfy Ccunry f��. -{yp�7f CJwr:ersnip <br /> ORPHAN GRAIN TRAIL, INC Hall 4p � �J�_�npraliY CorG�ratipr <br /> r Stale 4Viizre Irr,qrprrra:ed � ��!��r(Specifyl <br /> treei pr Other Mailing Addre=s <br /> PO BOX 1466 NEBRASKA <br /> �_�ty 5tata 7ip Code Actual U31ue Parcei or Locatior!p tJumher <br /> NORF�LK NE 88702-1466 111,963 400424584 <br /> Legal descripticn o:'real property and genara!desaription of all t�ngible parsonal p!oparlv,exaept litensed moior veh!cies: <br /> FAIRAGR�S DAIRY EIGHTH SUB LT 2 (427 N SHADY BEND RD) <br /> Title af OYficers, <br /> N��� Directats;or Partnere Address;City,State,�ip Gode <br /> y r ----------- --------,-- - •-------- -- . . _-- --- - -- --- <br /> ---I�a---ma���.-__G1�2�Ike r e s a�den t 8r+6�T-I�aaar-�o a�; No r�o ITc-, Neb'z�a s� 3 8717I."....�-------------- <br /> C?aTton L. A�drew Vice e ' <br /> 2l1 S. llth Street Norfalk Nebraska 6$701 <br /> S e e a t t a che d 1 i s t o r c omp 1 e�e---1 i t zn_g---o f Boa��_o�_I��i.r�e.c.�.ars�----------------------------------------------�._......--•--- <br /> Prepert�j cesr.ribad�brrve is�sad in the fdloH;inr exH!ript ca'teynty�(�iiease rriyYk the applicablP baxes): <br /> �A�ricultut2i%Hcriiculiural Society" � Educa:ional �' ReEigiou� �CharitaFile �Garnetery <br /> Gi��a a dataif�d descnption of the use of tha prope�ty: <br /> Collect, distribute and �ransport humanitarian relie� product5. <br /> "�gricultural/Hurticultural 5n�lety does not need to complete the iollowing questions. <br /> `s all a1 the property usad exc!usively as describ�d above? �YES �ND <br /> Ir a riortiar:of tha prcpe�ty�used fut ttie sain nt e.lwhoiic beverayes? �YtS �NO It Yes,staiP tha nurribe>oF hcxirs Wer week <br /> Is the proparty nwned or used by an organl�ation which discr�mir,atas in <br /> membership or empl�yment b�sod on race,colpr,pr naiicna�arigin? �Y�S �fd0 <br /> Under penatties ct lasv,I doclare lhat I have examined this c�rxxempiion app;ication and,to ihe 6est of my knawic.dge ard�aliel,it is carrect and <br /> r.omplete.I as�declare that I ar�i culy autt:trized to slgn tliis e�err�pfirni appllcatiun. <br /> �� <br /> ����"1 � � �� �zr c� y� ra� ll-z-/-z.o �/ <br /> ���� :horiz d Signa:ure 7iile na:� <br /> �...�_.-_•-_•-------�.-••._--•-°-°�_�----••••-•._T -••-----•-•--°----- ---------___.�_••-•.�_._ .�-•••••••.._ _��--••_- <br /> FC3R COl7NTM ASSESSOR'S RECOMMENDA7iqN <br /> �A"PHOVAL CbNtv1ENT5' <br /> C,,; A?PR�JJAL OF A PDRTIOM <br /> C ❑ISAPPRpVAL � � `"�` \�— <br /> Si_yr.atu ' �ewity Assessor Date <br /> ----°°•-..___.._ •-°°--"----__..._-••-�---------°..__.. ----•°-°•-_•--------- -• -------------°..._............ •-°°---°-----------------------._.....,-•••--•.....................----------,-- <br /> FQR GOt1NTY BCIA QF EQUALIZATIDM USE C1NLY <br /> I declare liiaf,to ine Cebt u'I my�nowiedg°and beliet,the deir,rmin�ticn h=rehy r�:ade hy.ha Caiinty 8oard nl Fyualization is r.�:rrect pursuant <br /> to the lav'�ot the�tate cf Ns6raska. <br /> �A!�PHQVED COMMENTS: <br /> u A?PRflVP.L.C�F A PbfiTION �• ••_�___w_ <br /> C DISAPPRQV�D I`��l"`�� <br /> Sig�iature of C rr ar 1.1embNr �r'"'�:�� a:c�= <br /> de6ruska Gapar:ment ut�aVenue ��19M6u�' "b�'�.CRe""St . ,0! <br /> 54•135-1999%iev.'7-201a 5upersedes 96•735-1999 Rev.77-�008 <br /> DEC 0 2 2011 <br /> F'LEASE MAKE A COPY FOR YqUR RECC7E�DS <br /> �I�t�� L'1�t�14lY f�SSESSOR <br /> ���r��3��.an��,����ASKa <br />