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vcwt� _ -�_ _ . _r.r.... <br /> CourJrY�55�ssoR for Tax Exarnption on Real and Persanal Property by Glualifying Organizations 45� <br /> Read lnstructions un reverse side. <br /> Fafiure to properiy aompiete or f�e tfiis application in a timely manner shall result in a disapproval of the exemption. � <br /> Name of Organizatron Counry Counry No. Type of awnership <br /> .�_ �" � ., . 7� � �.�1�� � ��^1 �,.- �� �\, �NonprotitCorporatian <br /> �t C ��.�1 _1 V f7 Q : -- _ Other 1SpecrTy) <br /> Street or Other Mailing ddress State Where Incorporated ❑ <br /> � � G <br /> , �„ , C-=���rt� <br /> �` C���� C�] ,,:��t�r'"�w�' ��:,C`> <br /> ��ty State Zip Code Actual Value Parcel or Location ID Number <br /> L._"� �n i��:J. �'��t� S <br /> Legai description of real property and general description oi all tangible personal roparty,excepf licensed motor vehicles: <br /> ,.��'.�\ c1�- �r~a.�'� c�.�'� �,.3`�l.�r�� <br /> �(�� �� ������y �.�� <br /> ��-�� �s1�� . <br /> Title of�fficers, <br /> Name Dlrectors,or Partners Address,Clty,State,Zip Code <br /> � ` mm <br /> prvperty described ahove is used in the fopowing exempt category(please mark the applicaWe boxes): � <br /> �AgriculturallHorticultural Sociery" � Educatianal ❑Fieligious �}'CharitaWe ❑Cemetery m <br /> T� <br /> flWe a detailed description of the use of the properry: <br /> Provision of healthcare <br /> services to the community <br /> 'AgricuRural/Horticulturai Society does not need to compieie the following questinns. <br /> Is all of the property used axclusively as described above? �-YES �NO <br /> Is a poriion oi the properiy used tar the sale af alcaholic beverages? ❑YES �NO !f Yes,state fhe number of hours per week ._,. <br /> Is the pmperty owned ar used by an organizetion which discriminates in <br /> membership or employment based on race,color,or nationai origin? ❑YES �NQ <br /> �r�er penalties oT law,I ectare that I have exemined this exemption epplicatbn and,to the best of my knowledge and belief,it is correct and <br /> complete. Isv declare tha am duiy a zed fo sign this exemption application. <br /> sign v � C�=� � 1 . �� �1 <br /> here Authorized Sig re Title Date , <br /> FOFt CflUNTY ASSE bR'S RECO�N�ATtONt __ <br /> � APPROVAL COMMENTS: <br /> ❑ APPROVAL�F A PORTION <br /> ❑ �ISAPPRdVAL �`�=1'°�� <br /> Signatu ounty Assessor Date <br /> FOR CqUNTY 80A OF EQUAIJZATfON lfS�OMLY <br /> I declare ihat,to the best oi my knowledge and belief,the determmation hereby made 6y the County Board of Equalization is correqt pursuant <br /> to the laws of the State ot Nebraska. <br /> � APPF?OVED COMMENTS: <br /> �-- rm- �c='� '�"�" � �� <br /> ❑ APPR�/AL OF A POI�TION �'� �� � �� �� �,,., !'�- '� <br /> .�... �. <br /> �; �:��_�... ,..__� <br /> ❑ DISAPPROVE� �r ��� <br /> nalure ounty 8oard r Date <br /> Nebraska Department of Revenue Authorized tiy Neh.,Hev.Stat.§77-202.p7 <br /> 86•195-1999 Rar.7-2010 Supersedes 96-138•1989 Rev.11-2tlOB i_,nk ��,� <br /> I�ah�3.,.�. �Ui.,i'v( i� �w,�4,�u7��. <br /> �;r�'ir;;°•.�9��_';���i,1'ti`4��irl�r�1�, <br /> PLEASE MAKE A COPY FbR YOUR FtECORI]S <br />