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� 20� 2 <br /> ,-� �waT� Exerrrption Applicatiar� �o�� <br /> ��� forTax Exemption on�teal and Personal Property by Qual'stying Organiaations ��.� <br /> DU 7Y/'+S SSQR Read inatructivns an reverse side. <br /> FaiEure to praperly ct5mplete or fite this applicativrs in a timely manner shali resuit it�a disap�roval mf the exemptian. v�� <br /> ' ram of Organiia[ion County Geuny i�a- -fypa of Ovmership <br /> � PEACE LUTHERAN CMURCH H�II 40 � ��Onprpfit GorP�ratior, <br /> Streei or pth,=,r Mai;itip Ad:'lress <br /> State`Nh�rr trcorprunied � �ih�r�Specity] <br /> 1710 N NORThi RD NEBRASKA <br /> �i� Staia 7.ip Cndr� f+etual ti'al�.�e P2rcel or Locatior IfJ MumLer <br /> GRAND ISLAND NE 68803 2'2�'93z <br /> Le�al des,riplicn o`real property and gena;a!desc;iption ef all tangible parso�al property,except licensed motor veh±cies: <br /> R�B SUB LOT 39 (CHIJRCH)#40016q242 <br /> p�ACE LUTHERAN SUB LT 2-�019 CANNON RD#400164612 <br /> Title of Dtficers, <br /> �a�� Directars;or Partners Address,City,State,�ip Cade <br /> ---°•°--°••--•-••-----°°------�••.•-----W••--- -_°••m_-------..�••-_.�__ ___-••_•••-- _.-•-••-.•--- --•----------��.._._------- _.-•••- <br /> etzp �hcsirr*+�.•, 2� z:3 S+eu.�ar-+ �. �o�uwv(ZS�c+ ►J� 6FS�o <br /> Ji RA��r �c.eCY+ui,-- Z�hib SQi`v�rv,�.�, C3r�,ncaL '�s►Ar+�t�lE (� �So <br /> � 1"1 � a s , ti�, i.J 6 G r n:d.�.S 1 A�'h <br /> —�i��L �A�1-,�.�12-- •--- c—�"'e-�-=------_�_.__ '�1_!-�.�..�_1�V1_C_�;_rz�.Y,�r.-.---�a����__�.,.,�1&s�d.—��..__����-- <br /> Preperty Gescrivad ahrrve is usad in the followinE exempt�teyr�ry(piease mark the applic.at�l�bexes): <br /> �A.gricul[uraiih{cr.icuKural SocierP � Educa"ional �Religio��a �CharRable �Cemetery� <br /> Giva a deYsi±ed descr�ption of the use of the property: <br /> �}�'I,l..r�r 1'7 _ Y"�1 ��-�.�1� Cc G"��� x� ;�-�,�s �n d� �q r)c,";.,� <br /> "Agricultur�i/t-lorticultural Saciety daes not need to complete the taliuwing questions. <br /> �s all qi the praperty usad exciusively as described abova? �YES �ND <br /> Is H portic�r:of th�prcpem�us�d for TY�F saie nf eJwhniic beverayes? �Y�S �Nq H Yes,sta?e the nurriber n?hcxirti wer week <br /> Is tha property owncd ot used 5y an organizaiion which discrimir,atcs in S <br /> membership or employment based on race,ccbr,pr nat;cna!oriain? �Y�S ��d0 <br /> � � <br /> Under penalties ct I�sv,I doclare that I have<xamined this exarrption appiica�ion and,to the 6est ot my icnowiedge and Ealief,it is correct and <br /> r,amFi;ete.I aiso, c�clare inat I am culy authnrized to si_r,n ti�ls exernp1ion applicatinn. <br /> .! � � <br /> S;�� �4� S��'►�� I�G S i-� 11 ���►; <br /> ��ir��Authorizod Signature Title nate <br /> --°°-••. --_ _•-------�••--_---°------_.-.••.------- _•••--.•- �.•-•-•••••••-•-••------------°°°------ -°•••••--.•- �•°-°°---- <br /> FDR CQ1�PiTY SS SSOR'S RECQNlMENDAT30hi <br /> A;'PROVA� GDNA.iE1��T5: , ��.! n .n i[ � L���q -- <br /> � <br /> � APPFiUVAL OF A P�R71bN <br /> ❑ DISAPFRQUAL `'~ 1�-�`� <br /> Si�natur Ceunly Ass6ssor bate <br /> ••---- -��••••�----------°-°-------_-•-•-_-------._------°•••.•-•-.r-----�_.. �....._..._...�---, -•••.--•..-•.-- �••...�.m_-- --°••••.-. <br /> I�� FQR CQUNTY BOA OF EQl3AL12ATiCJN USE ONLY <br /> I decJare,tiiat,In i��e Cast uf my knc�wiedys and beliP(,the detsrrninaiicri h°rehy rrade by.he Gounry$oard nf Fyu:�{iza'iinn is cerr�:r,t pursuant <br /> 10 the lav�s of the State c�t Net�raska. <br /> ; API�FI0VEL7 GC3MilA�M75: <br /> Lj A?PRdVP.L C)F A PGl�TIQN _•••_--�...• -••-------- -----_-•••••••-•._------- -----.•--•.-••---------------�_�;,,�����s7 ���-°---- <br /> ❑ L715APPRGV�q / �J`"�' <br /> .ignature af C rt� ard.1eml�er Q ! <br /> Nebraska 6dp+�rimeni ut aevenue ( [ .Mlthvr�xed by Ne6.Fev.Stxi,§7r-202At <br /> 36-13�•79997ev.7-c�iPSupersede596-135-1999Re�.11-H09H �A�„� `Pt..sl9�iti;�� ��v�i-.,�3V�11 <br /> GRW�U icL��f��?,S�'�B�ASKA <br /> PLEASE MAKE A COPY FQR YOUR REC�RDS <br />