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20� 2 <br /> T ������aw�T� E��rr�pti�r� �ppli�a�i�r� ����� <br /> vou� ���-�ax�x�mptian on R�a! and Persanal Property by t�ualifying Orgar�i�atio�s <br /> UNl`Y nSSESSpR Read instructians an revcrse side. ��� <br /> Failure to�Sroperly compief�ar fiEe this application in a Eimely mannsr shalE result in a tiisappraval of the�xemptian. <br /> name ot prparitation County Geuny fVo. -Fype of r�wr,Ership <br /> BETHPHAGE HOU5ING CORP 1 M05AIC H811 40 Q r���Grolit Ccrporatior. <br /> Streei pr CJthPr A,9aiii�i�Addre=s State`Nlizre Irc�rt�r�raied � !��ih-r(Specityj <br /> 4980 5 118TH ST ATT: NANCY HALLIBURTON NEBRASKA <br /> City StatQ iip Cnde Actual Value P�rcel qr Lacatior ID Nurri6er <br /> OMAHA NE 68137 184,259 4003269D6 <br /> Legal descripticn o:`teal property and�ene;a;dasc;iption af a31 t�ngible p�rsanal p!qperty,excepY ficensed mator veh�cies' <br /> CHATEAU ORLEANS 4TH Sl1B LT 1 (2922 W 57H) <br /> Title af Otticers, Y <br /> Name Direckars.or Partners /�ddress.City,S�ata,Zip CvdW <br /> •---•-•..:-•-•.�.-�----�----...._����......••••.....�W---------------------------------------------- -----------------------.......--------------------------'--------.......----------------------------------------------.........-•------------------._._.. <br /> Linda Timmons PRES/CEO 4980 S 118th 5treet Omaha N� 68137 402-896-3884 <br /> Cind Schroeder CFq Same as above <br /> P�'C.'�]E�t�C85CI'IL�B(�iiFJfiVB I5 LFE(�Ifl tI10 fOIIOW'IYI�P.X9!71�1t l'3tL'�Of��;piease rnyric the appl:cablA 6oxes): <br /> �A�YiCUlI4)3iiHGYiiCUllufal,SOG:et�/' � EdUC3tiP11dl �R911gipua �G"h�rjt3ble �C9mgtefy <br /> Giv�a detai!Ed descr;ption of iha use oilha prep�:ty: <br /> This property is used exclusively in full filling Bethphage/Mosaic's mission ta serve <br /> people with develapmental disabilities. Bethphage/Mosaic is registered with the <br /> Secre�ary of S�ate Office as a Nebraska non—prpfit Corparation <br /> ",�gric:�ltural/Flurticu(tural Society does noi need to complete ihe f:�ilowing questions. <br /> Is all ot,he prap=rty usad exdusively as d�scriL-ed above? �Y�S �NO <br /> ir h��:�rtior.of the prcr}srt����s�d ior ihe sa;E r�f alcohuic beve'ages? �YtS �Nq 11 Yes,st•r.?e the nurnraer r�`haurti pesr we�k <br /> Is the prrp�riy ownad or used by an organizalion whlcl-:discrimiratas in <br /> membership or emplpyment besed on race,cclar,er nat;cna!orig!n? �YcS �Pdq <br /> Under penaities ef 13s5,I declare ihat I have examin�d tir;examption appiication and,to the 6est of rry<now!cdg:ard baliet,it is conect and <br /> r:nmpic�fr�.i aisa .rk-1s hat I am uuly auth�.rize o si_r.n tliis exern�iiinn appl!catin�. <br /> ���� � V.P. Fixed Asset bevelopment <br /> �Au°.horiz, aignaY�re -fitla ba;e �� ) � <br /> ���� <br /> - --------------------------------------------_.-_-------- -- �------ --------------------------...--- <br /> --��-------------------------------- I <br /> --�-�----- <br /> _ _ __---FORCQUN7YASSE550R' .....G_. - <br /> S A� OMMENDATIOPJ ,,,....._ —_._.._......._. .�......_ <br /> ' R;'PFiDVAL COM1lrv1EFJT5: .�._.� _ _i l - <br /> � -- <br /> [� A?PI���VAL 7�A PC]RTIOPJ <br /> ❑ DISAPFROVAL � �' — 1C��� <br /> Siqr.ature o, uniy AsseSSor � p;�xN <br /> -•-•-.•-••••..-------••--°--•----------•••••••-.•-••--•••••--•......��....�.•------°--••-----._.. �•••••.:.........-•••••-• •.-.._ <br /> -- - • ---- ----------,-•••••.-----------N Ll'--------------•-•••.•.•- ...-•-•--.m... <br /> � FQR COl1NTY BO,4FIC7 EQ4lA#0..fZATION t1SE p-----. I <br /> I cleclarN iftat,tn'Ihe k:e.t nf my Xriqw:erJy°and�eliei,the dr:1errrcnaticn hereby rr;ade by,tie Cnunry Foard nt Fraualiz,alion i5 cerrF•r.t pursuant <br /> 10,he lav s ot the State of Netiraska. <br /> �Ai'PFt01/ED COMMENT5: <br /> ... <br /> L; A?PRpVqL(�F A PORTlON <br /> ❑ L]ISAPPHGV�L7 �-�:,I�� <br /> .ig��ar,ure ry4 Cour: uartl 1, mUer _ `r,,�,.�, � <br /> - _�1�' <br /> 'e6rdska pepar;ment uf�evanue 1'� �.AVRiiuririsd'$�"deb'�Fee'v; iat,§77-202.0? <br /> d•73^•1989 Fle6t 7•�010 SUperSedes 96•735•1999 Rev.71-?009 <br /> NQV � 2 2011 <br /> PL�ASE MAKE A COPY FOR YDUR REC(7RDS <br /> ��±t'�ly�� [."r�l[.�i�r: 's' rn+�`�4lf-�v`)Un�1 <br /> L7f1f5P\�S�u�.hi�\•�.�. I��L�.�iY�,J�irS <br />