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TcJ BE FILECs WITH �O� �
<br /> Ex�mption �4p►plicati�r� �o�M
<br /> YouR forTax Ex�tmptian on t�eal and Persanal Property by Qu�iifying Organizatinns .j
<br /> a�JI�ITY ASSESSQF' Read instructions on reverse side. � 'o„��` i
<br /> � Failure ta property complete or fi{e this application in a timely manner shaii res�lE in a disapproval af the sxempt[on,
<br /> I�ame of Orgarization County Counry�Jp. -�'ype of O�r�r:arsnip
<br /> CAMERON C�MM CHURCH & CEM Hall 4� � PJonprclitCorG�oratior.
<br /> Streei or OtPier Maiiiric�Address State'Nhzre trcor��nra?ed � �ihar(Speci?yl
<br /> C/O KEITH HINK50N NEBRASKA
<br /> �ity StatQ 7.ip Gnde AC{ual V31ue Parcel or Locatior,Ip MurnL-er
<br /> CAIRO NE �gg24 42,710 400196395
<br /> L�gal dasaription o`real�raperty and aenerai description of all tangible parsonal p!operty,except lic°nsed moto:veh�ces: �
<br /> CAMER�N TOWNSHIP PT SE 1/4 22-11-12
<br /> Title af Officers,
<br /> Na e Directors.or Partners Address.City,State,Zip Gade
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<br /> PfC�l.;'L�G�5f.I'1112(I iiF)fJVB I5liF8fl I!I tFll:fUIIGWICIC!f:.%N"f��71 GaY.�f�fj(y i�'JiP•d:E(fldt'{C III�Fi��IiCB�Ie bexes): � �J
<br /> �A.�r:cultufa!iHor�iculiural Spc�ety" � Educa*.ional �R�li�iou� �Charita�ile ametary
<br /> Giva a daTal!Ed dascr�ption of ha use oi tha propsrty: r
<br /> �w�w�Vhl ��.�, `'�- �G�dI�.! ��_ V
<br /> �,��. Ps�,�l � ����1 � y
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<br /> "Agricultural/Murticuitural 5ociety dnes raoY need to complete the followln quastion�. �
<br /> 's all oi the praperty'L'Sdd C%G�1151V61y P�deSCtIbET�8bDYc? Y�S �ND
<br /> is�rioetinr.of tha prc��r�t}��3sed fur the sa�e nf e.lcoh�iic beve°ay�s? �YES !C) I;Yes,sta?e the nurr�h;r:r d'hours per week
<br /> Is the proparty own�d or used by an organization whicl�discr�mirates in
<br /> mem�Qrship or omployment bFsed on raae,ocl�r,or naiicna!orig;n? �Y�5 JO
<br /> Under penalties et law,I dociare that I have examined thic c�:amptioil appiict�tion and,ta ihe tasf oi rr��knowiedg.:ard Celiet,it is correci and
<br /> com��;etw,.I t�iso decl:�re tnat I arn culy authr,rized to slcn tliis e�ernpTinn appGr.atir��.
<br /> sig� __%1��c�v-� ...._� '�-I°Z� `�
<br /> � , or¢ed 5ign �re Title Daie
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<br /> _ NfMEEdDATlON
<br /> FflR COIJtJFM ASSESSpR'S REGO �
<br /> �A'PROV�L GOtdME1JT5: - - ���,�� _
<br /> � A?PRCJ�IAL(]F A POR710N
<br /> C OISAPPROVAL �. � - �
<br /> Si_yr.ature :C uniy Assessor D�t�`
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<br /> FOR COUNT`l BDISR EqUALl2ATIpN USE ONE.Y
<br /> I declarc�tliat,tu'the h�st uT my krinwiedg�and�elief,the detarrninat�un h°reby r;dde hy.f�e Gnu�iry F,n:�rd ol Fqunlization is cr.rrer.t purs�aanf
<br /> to ihe lav's of the State of Nebraska.
<br /> � A?PHRVEI7 COMMEN'7"5: .
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<br /> �,; A?PAOVP.L C�F A PCJRTION
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<br /> e6raska Depar;ment ut Revenue .4utF�pi;�ZedfbY����?�•pY�����ti����02.p?
<br /> .6-13�-1999 Rev.7-2010 SUpeY�edes 95•135-'999 Rev.17-=008 '..',�t,`��,.:�. . ��� �`
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<br /> PLEAS�MAKE A COPY FQR YOUR RECORDS
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