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2012 <br /> ca��Fi��awi�� E��t�ptian �,ppii�atian Fo��,� <br /> YOUR {�rTax Ex�mptiort on Fteai and Personal Prop�rty by Qualifying Organizaiiars <br /> C UNIY ASSESSOFI Read instrucUona an reverse aidc. ��� <br /> Faiiure ta properly cqmplete or fife this applicatian in a timely manner shall result irr a�isapprovaE�t the exemptipn. <br /> �ame�f prgani�alian Gounry Geun„���a. Eqpe�f Owr�ership <br /> � P�onprctit CcrGr,ratior, <br /> BETHPHAGE HOlJ51NG CORP II MOSAIC Hall 4b <br /> Street or(7tlisr Maiiin7 Ad:iress St�ie`�/har�Irr,orr�r�ra:Pd � C�thar{Specityl <br /> 4980 5 118�H ST -ATT: NANCY HALLIBURTON NEBRASKA - <br /> C{ty Stato iip Cnde Actual Ualue P�rcei or Locati�r ID Num�er <br /> OMAHA N� 68137 186,339 4pQ107139 <br /> Legal descript;en o:`real property and generai desc;iption of a31 tangible parsonal prppert�,ex,ept licensed motor vehlcies: <br /> WARRENS 2NCl Sl1B LOTS 1 &2 (3D01 W NORTH FRONT) <br /> -------------------------------- � <br /> Title at Otiicers, <br /> Narne Directors.ar Partners Address,City,5tate,Zip Cs�de <br /> -•�.-.•-�-•••--••-.•�--�•-- --------------_..-�•--°._---- -- •••-•-----------_•._------ - <br /> --------------------_•_••--••. - � •.-�• • • ...._ <br /> -- <br /> Linda Timmans PRES/CEO 4980 S 118th Street, Omaha N� 68137 402-896-3884 <br /> Cind Schroeder CFO Same as above <br /> - -------------__---------- ------------•------------__ <br /> �..____ ( .�.._. .�..._.�....__..�.._...�.._._�_W� - -- <br /> Prepe;t�j cesc:i•ii,ed�hnve is usad in the tollowirip�xr;rnpt cAteyory�(piease rnark the applica6l�6exes): � <br /> �Agr:culturaiiHcY;iculiural SoC�eh!" � EduCa?io�lal �Refi�iou� �,r,"haritak�le �CemetAry <br /> Give a detailEd descr�ption of ha use olthe property <br /> This praperty is used exclusively in full filling Bethphage/Mosaic's mission ta serve <br /> people with develvpznental disabilities. Bethphage/Mosaic is registered with the <br /> Secretary of 5tate office as a Nebraska non-profit Corparation <br /> "�grie:fltural/Hurticultural Sociaty does not nesd to c«mplete ihe following quesiion5. <br /> I:all oi:he proparty�used sxc!usively sa destribed abova? �YE.i �NO <br /> I�a��:�rtinr.nf ihe prcrir�rty used tut Tti�saie oi alcohu!ic beve�ayes? �YtS �Nq IiYes,s1:�iP the nurnb�:�n`hours per wr-.ek <br /> Is the properly nwned o�'used by an organizatiori which discr!minates In <br /> membership or empl�_�yment basbd on race,cclpr,ar naticna!origin? �Y�S �PJO <br /> Llnder pcnalties cf lass•,I deciare ihat I have examined tir�ax,:mption appiication and,to the L-esf of my knowladge ard qeliei;it is careect and <br /> compiete.I aso declare lhat I ar�,duly aathcri��i to sicn th;s eserri��tinn appGc:atinn. <br /> 5���"1 V.P. Fixed Asset Development �\-�j-�p� � <br /> ��t.� �Au:honza oignatur T;tle Date <br /> •--�-�-•••.----°-••.__---------_-_°--_-_-------------------------------�-------------------------�------,--------••---�_...-•.�--••••••-••••••.•••-------------------------------------- <br /> J� FDR CC}UNTY ASSE550R'S RECON1i�AEtdI3,4Ti0N I <br /> �AnP l0`.`.•;� G.^�f.t�iE�JT�. �ISC o r�,-.,, n C �„ — ^ <br /> L A?FAbVAL OF A P�RT1JPd <br /> ❑ ❑ISAPrR6VAL ___�`��T��„ <br /> Sigr.ature ar ui y Assessor Date <br /> �,�------ _�•_••�-•--..��-------_�_-••---_•.•••�.------_••--._��..�_...•_.._-� • • • • - - -• ---------------------_.........••-•••-•••. <br /> -- -- - ----------- <br /> L F4R COUNTY BqARD f] L!0.)ALIZATION USE ONLY f <br /> I dec(are tliat,tu ihe:k:esl u1 my knnwiedya and beliei,ihe deterrriinaticn trereby r+a.de by,he Go4irity F,c+ard p7 Fyualix.aiinn is r�^�rFCt pur�•u� <br /> � .�nY <br /> to thr lavs nf the State of Nebta.ka. <br /> �A?I�HOVEi] CpM�AEN75: <br /> --• <br /> L; A?PROVAL OF A PORTION <br /> ❑ DI5,0.PPFtGV�D � � -.�'�� <br /> .igr�eture af aurry F}na%d ti1 ml�er _ , �t.�- ! ' ' a►�4 �'� - <br /> ehraska Clepar;ment ut Ravanue �":Authn��ed by'deb:Ftav;��tat,$77.'ep2.0' <br /> d6-133-7999 HeV.7-�010 Supefsades 96-135-�988 Wcv.11-i006 <br /> NOV 2 2 2011 <br /> PLEASE N1AKE A COPY FOR YDUR AECORDS <br /> H�Y��. �r�.��i':�('r' r,;;;;:�'�; . . <br /> �1�1'�r�l��M}F;i'��! ' !:�;i:;.' .. ,, <br />