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_ 20� 2 <br /> rc a�Fi��nwiTr� Exempta�n �pplica�ior� F���� <br /> YOUR forTax�x�rnption on �teal and Persana! Property by Qvalitying Organizatirsrrs <br /> GOUNTY ASSESaQFi Read inatructians on reverse side. ��� <br /> Failure'tn prop�riy complete or fi4e this appiication in a Fimely manner shall resuit in a dasapproval of th�exernptian. <br /> Name�f Organization G'aunty Ccuntg No. '�ype of O•r+r:ership <br /> CENT NE GOMMUNITY SERVICES INC Hall 40 � �JonprotitGorppratior <br /> Street or pthar h9ai;insl ArJdrr=s Sfat�\Nhare lr,r„rr��nra<.ec � �ih:r(Specityi <br /> PO BOX 509- 626 N 5T NEBRASKA <br /> �;.i{y Stato 7.ip Gr�de Actual Vab�e P�rcel or Lcca[i�n ID�IurriL-er <br /> LOUP CITY N� 68853 197,247 400086778 <br /> Legal descripi:en o'real property and ganarai de&cription��t ail tangible parsonal prop�rt�,except licansed motor veh!cies: <br /> RYDER PARK SUB LOT 3-2525 OLD LINCOLN HWY <br /> 7itle af 0lficers, <br /> NarrFe Directors,ar Partners Address.City,State,2ip Cade <br /> �..��--�••-�•••....�...�. ..._...•---- ��_�••-•_ ..--••.••••-•-••--_•_--�.�.�---------- --------------------- <br /> �_e.`Feeken: :'- Board Presiden Box 64, St. Paul, N� 68873 <br /> Carol Krilcac Vice-President P.O. Box 1, Comstock NE 6$828 <br /> Pam_WHarrin�ton_._ Bd. Sec/Treas. 79660�476th Road, Laup City, NE 68$53 <br /> __.Jose__Zapata-----•_^---------�?�ec.Director . P.O.__ Bax__509_z..LouP....City-1---NE_._68853----f-------------------------------- <br /> Donna Qbermiller Fiscal. Directo P.O. Box 509, T�ou Cit , NE 68853 <br /> P�'epe,t�)dasr.rii�ad abnv�is uEed in the folinwiri�e:xe�ript category�(pieasE myrk the applicabl=bexes�: <br /> �A,gricultur3i%Hcr.icutiural Socieh!' � Educational �Reli�ioue �Charitable �Ce,�netery <br /> Giva a detailed descr�ption of iha use of ih�prope�y: <br /> Administra�ion of Human 5ervices Organization includi.ng Commodity Supplemental Food <br /> Program, Outreach Services, Suppor�ive Housing Program, Thrives Program and SSVF Program. <br /> "Agric�lYural/Hurticuftural Saciety does not need tc�complete the following questions. <br /> I�all of;he prnp°rty used exc�u&ively as described above? �YES �h10 <br /> 1�a p:irtlnr.of iFie prariF��Used t�it ttie saie qt alcohoiic beve°ages? �Y�S �tJ(] 11 YPS,sia'e tha nurnY�r:r n9 haurs p�r u�eek <br /> is the prrpar{y owned or used by an organlzation whieh discrl�ninatas in <br /> m�rci�ership or empl�_�yment based on race,cclor,er naticna!oriqin7 �Y�S �PdO <br /> Under penalties cf 13sv,I deJaro that I have examined thi�examptiun app;ication and,to 4he bcst of rr,y knpw!�dge ard 6eliel,it is conect and <br /> r,nmp�Ete.I a;s�dec.lare inzt I ar��duly aathcrized to s3pn this esernpiiun ap�lir.atinn. <br /> S1L��'1 ��;�r,�,�r1�-- �"{�I'Y�.L�.1� Fiscal birector 11/22/2011 <br /> i��y�� AuYhorEz�d 5ignature 7;tle Oate <br /> 1! <br /> •-_._ •-.•••-•-�._---------••-_••• — --------°---•-•.-••••••.....•••••••••••••••-••-•-••--.._..•.••.•-•••----------------------------------------------------------� <br /> Y�-•.••••.�FOR COUNTI'ABSES��R'S RECOIVtAAEPJDA710N <br /> �A°I'HOV�1L GQlwtvtENTa: ��(�5�� ���-----��� <br /> 07.., <br /> Lj A?PROVAL OF A P!'JRTIOPJ <br /> �� <br /> C ni5�p��a�A� �- 1 -- l°t— ��_ <br /> Sigr.atura ' eu ty Asseas Date <br /> ----_-�•••••-•-•-_•-•-..._-------._..-••-•-•••._-------°••--•-_----�_•••-•••-•-�••�-------------- -- ------------------------------------------------------�.-•••-••--•-••.-•-•..•�••-••---•••-•.....................•-------- <br /> FQR COUNTY BQIS� F�LPUoAI.iZATIpN U5E qMLY <br /> I der.fare.tiiat,tu 9%�e rest ot my icriuwiedg°and bel�et,the deterrriinaticn tierehy r+ade 6y.he Guiinty 8oard of Equaliz.aTion is:r.rrect pursuant <br /> to?h�lav:s otthe�t:�te af Nebratka. <br /> � APPROVED COM?�AEMTS: <br /> � <br /> A?PFl(3VP.L OF A PC>FiT1C)N <br /> , <br /> ----°••••---°—�-�"=_------ ----------------------- --------------------------------•-----.� •--- <br /> •--•••--•••••.._ ..•••••••.............•--•••• <br /> /�/—/� <br /> ❑ uis.aNp�tav�❑ ?"., , ;�"�: .'�, <br /> .igna[ure o ourty 8 ' , em r � "���..��i_Cla' ;, �C�'� , <br /> Ve6raslk�4spar:mant ut aevenue � .4uthoriiad�hy'de4.Fqv.Stat.§T7•202.a� <br /> y6-13�-7999 HeV.7•m01tl 5upersedes 9fi•135•1999 HaV.11•"��8 <br /> NQV 2 3 2011 <br /> p�.�aSE MAKE A COPY FORYDUFi RECORDS ��;LL. Cf��is���.�'�r� i�����5�� <br /> �Fi/�i��P�€_�,6�r;; !'�EBf�kSKA <br />