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2012 <br /> � BE FILE[7 WITH �����tf[�n Mpp�E������ FB��,�JI <br /> co r��n'Mss sor� �°r��' � p�ian on Ft�a! and Persorral Property I�y Qualifying t3rganixatior�s ��-� <br /> Read instructions on reverse sidc. <br /> Failure ta prope c pl�te ar file this appiicatian in a timefy manner shalt resuit in a disappro�•aI at tlze�x�mpiian. <br /> ':, ame of Or�ar,iza[ion County Guun':�IJ�. -l�ype��f qwncr5hifp <br /> BETHPHAGE M05AIC Hall 4D Q r��nprotitGorporatior, <br /> ��t�eet or Ott�=r 1,9ai:ing Arldr�es 5[ate`�^Ihzre tr,r,�rr�r�r�?ed � C�iher(upecity) <br /> 4980 5 118TH ST -ATT: NANCY MALLIBURTQN N�.gRASKA <br /> �i1� Stato i ip G:�de Actual Val•�e Parcel pr Lqcatiar ld NumL-�r <br /> QMAHA NE 68137 1,352,453 5EE ATTACHE� <br /> �egal descripticn o`:real prnperty and gene;a'description at ail tangible parsonal prop�rty,except licensed mo1o;vehicies: <br /> SEE ATTACHED <br /> 7itle af Otl`icers, <br /> �,7�me _Direckors;or_Partners Address.City,StaYe,Zi�;Code <br /> ---•°° •�••-�----------�••••-•--.• .. .....------------...-.°---------•••------------------------------••.------------------- .....-•---------- -- <br /> Linda Timnnans PRES/CEO 4980 S. 118th S�reet, Omaha NE 6$137 �+OZ-896-38�$�4 <br /> Cind Schroed�r CFQ Same as abave <br /> ---------- <br /> � <br /> Pr�:perty cesr.riii�d abnve is iised i�i the f�liowin�exerript r.ategnr��(piease rnsrk the applicabis bexe.5): <br /> �A.gricultural/Hcr�icultural 5ociab/" ❑ �duca<ional �Religiou� �G"haritaGle �Gs'neter� <br /> Gi���a datai!ed descr!ption af ha use ot ih�prope�ty: <br /> This property is used exclusively in full filling Bethphage/Mosaic's missa.on to serve <br /> people with developmen�.a1 disabili�ies. Bethphage/Mosaic �.s registered with the <br /> SecreCary af S�ate Office as a non--profit Corpoxation. <br /> ^Agri�ulturalMorticultural Society does not nzed t�complete ihe fuliawing questions. <br /> Is ali oi;he pro�°r[y usad exciu�ively as described a6ova? �Yt� ❑�ib <br /> ,�ry r�ortinr.iTf the prc(}eny i�sed r�ir ihr sn�e ni alc:ohaic trrverages7 �YeS �ND it Yes,sta?e the�iurnher n'hnurs per wrek <br /> is tha prqp�rty owned o�'used!�y an organiza�ion which discrunirates in <br /> mem�ership or empic�lment based on race,ocl�r,or naticna!orip�n7 ❑Y�5 �NO <br /> Under penalties cf I�s�,I daclare ihat I ha�e examined this examption app;ication and,to ihe 6est of rr��know:edga ard heliet,it i5 corre�t ar,d <br /> r.nmp�eta.I ais de-•r�Th.t I arn rSUly authr.ria ,io si_r,n this esernpti�,n applic,atinn, <br /> ���� r V. P. Fixed Asset Development 11/21/2011 <br /> 6.m���y �R , or�z�d Signat re � Title bate <br /> M6 <br /> ----.._•.•---------°•m_,--_•_-••••---�_..•------_....... °--....-----------�••-•-•••-•••----------------°°---°-- .••••-----------------._....... �••-•--°•� <br /> FqR CC}UPlTY ASSESSOR'S RECOMMEtd�AT30P� , <br /> ; APWHOV.�aL GpNM1E�JT5: �J.�n Z�—�Q c� ---- <br /> � <br /> �_ A?PRCJ�JAL pF A P(]RTlON <br /> C DISAPFROVAL �~ � 1 V �� <br /> Signature o G n1y Assessor D�te <br /> •.�----••W••..---------°----------»�.�_-------°.••_-----°-°---------------•_•.- •• ---__•••.••••.__ -•-••.---- .•-•-•.------------------------�......._.-- ° <br /> - FpR COUNTY BQAR EQUALIZA31Qh LPSE ONLY <br /> I der.lare.tiiat,ro 1he k�a:at o1 my knpwiedye and beliei,the delRrminaticn herehy r,ade hy:he Goiir�ty Board nl£yualir�tion is�nrrec.i pursuant <br /> ta the Ixws of the�Yate ot Nsbtaska. <br /> � A?PHDVEll CPMMENI'S: <br /> LiA?PAO�JP.L bF A PqR7iON -- -�-•••••�----- ---•-_-•-••__._ ------�-••••.-.--�------------ •-•••-•••-•, ••••-•••• �.-.•--••-•-•-••--•.•---°-•--------------- <br /> C DISAPPF�GU�D / �/~/� <br /> ' nature ut Cnur�ty Bo rd: .m1�N � 1 te , ,.� <br /> '�e6reska Clapar:ment ut�ev=_nue er, _' z :��t`aS. �ev ��al.g77-P02.0? <br /> 0-13�1999 Rev.7-2�1[1 Supersedes 96-195•;999 FieV.11-'O�B �,����`.:: ,�,���� ��� <br /> PLEASE MAKE A COPY FORYOUF�RECORDS NOV 2 2 2011 <br /> h�f��L G'v`'iJi1�l`�' h�S�SS�R <br /> GRh��1C�iSLA[.��?,rtii.��kSKA <br />