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� �0� 2 <br /> �`�o s�Fi��nwiT� Ex�mptivn �ppli�atior� ����� <br /> vouA forTax�xemptian on Rea! and Personal Property hy Qualifying Organizations �5.� <br /> CpUfVTY ASS�SSC)Fi Read instructions on reverse side. <br /> Faiiure tc properly complete or fife this application in a timely manner shal!result in a disapproval of the axemptlbn. <br /> �ame of Otgarization G'ounty Goun'.ry Na. -['ype af OwrerShip <br /> ' THIRD CITY COMMUNITY CLINIC Hall 40 � P�onprcfitGorporatipr <br /> SGeet vr pth=r Mai:in�AddrYSS Stale Whare Ir,corr�orsted � Olher�Specily) <br /> 1107 N BROADWELL NEBRASKA <br /> �_�ty Stato Zip Cude Actual Value Parcel or Locatior,Ip Numher <br /> GRAND ISLAND NE 688D3 145,083 400133172 <br /> Legal desGfipiion oi reel nroperty and gene�a�descriptlon ni aU lansible parsonal pCOparty,e)_cept licansed molor veh�cies: <br /> GILBERTS ADD 7D THE CITY OF GRAND ISLAND LTS 9 & 1 p $� PT VAC ALL�Y <br /> .j��° ���� ��l�1 <br /> Title af Dtticers, <br /> Name Directots,ar Partners Address.City,State,Zip Cvde <br /> � I-tG7�I LA �--- •-.•-••-.�- 117 ---- ��.--.••-•-_�.._-----�-- -Q ---�✓(o4�[Zrl7//.7�2�"I���...�_.��____----�- <br /> B���D [ � <br /> PreperS��desr.riiizd�hnve is��sad in the foliowirig�xwtnpt c.ategf�ry(��iea;e rn:�rk the applicabla hexes): <br /> �Agriculturai%Woriiculiural Socieh�' � Educatio»al �Religio�.�a �Charita6le �Cemetery� <br /> Crii�a dafai!ed dascription of he uee of iha property: ` <br /> ��,:P�� ►s � -r�-�ri d���oh -�'v►►d�d.. -�r:e,� yr�d,���.i �e�d �����1 c(��« -�� ►°�'�e <br /> l�o u7 l✓�covY1� C�n.�Uh i� � l n� ���1!c 15 -�eE... � `�i� `7�r r�P���`.tC' <br /> � <br /> "?,griculturalMarticultura!Society dnas not need tn cvmplete the followlr,g questlons. <br /> , Is all oi the�roparty used axc�usively a;described abova? �YES �ND <br /> Is�►�urtinr,pf tii�prc(�e�ty�usad far the sa�e oi elr:c�huiic beve-ages7 �Y�S ND 11 Yes,si�ie the nurn6ar of hcxirs per week <br /> Is the prop�rty ownad or used by an organlzaiion whicp�discrlminates in <br /> membership or empl��,ymant bGSed on race,cnlor,or naticn�!prigin? �Y�a �fd0 <br /> Under naltios cf lasv,1 declara that f havic examinc:d t3ti,examption app:ication and,to the Gest of my knaw!edge ar,d beiiet;it is corrGct and <br /> com��i61r. Iso der.lare that I arn c;uly auth;r,rized t�slgn ihis exernpiinn applicatinn. <br /> 5i��1i � � �rru I/ l� <br /> h�y�� �Auihorizcd SignsYure Title ➢aie <br /> L�.�__-�---------------�---------- --�-------------�--------....__----�----------------__�----�------------------___.._�__-------------------------� <br /> FDR COUNTI'ASSESSOfi'S F�ECqMMENDATfDN <br /> �A''PHOV:IL .^.0:•.I�tif:T5: � �' � .r.-,�-7'T�o�_� c�— � <br /> �r���� <br /> L; A?PRC�VAL OF A P(�RTIUN <br /> C DISAPFR�VAL <br /> Siana u e 'Ccunty Assessor D:�te <br /> ---...�.••_-••-•�-_•.-_--•- -�•--•••�•�,---------°•-••---°-••_.••••...._ ,..-•�•••---•-------•-•-----• •-------°•-----•.........................�••.••••...••••••-•.•----•-------------------- <br /> �DR COUNTY BO D dF EQl1AL.IZATIpN USE DNLY <br /> i der;lare ihat,to thP�ast uf my kri�iwiedgs anci belief,the detr�rminaticn hsrehy r,ade by;he Cnurity F.oard of Fqualization is::crrPCt pursuant <br /> to�h�Ixv's of the State ef Nebtaska. <br /> �A:'PHOVEU COMMENTS: <br /> ❑ A?PRS7VP.L C7F A PG�TIJN <br /> a� <br /> C qISAPPHGV�� �� � �—/� <br /> ,ignature ut Gour[y nr .9emliNr ��{, ! � <br /> Na6rdska Gapar:ment of Revenue Authvr;zad 6y Ne6�Feu.Stai.§77-2p2�� <br /> 38-13�•7999 Ree 7-�070 Supar�edes 96-795-1999 Rev-11•?006 �O� � � �a�� <br /> PLEASE MAKE A CpPY FQR YOUR RECORDS �..���� ���iV�� ��S�SSC��{ <br /> ��a�va�s��ra�: nEa��s�tp <br />