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Tp 6E FIL�D WITH Exemption Appiicatian +�o�M <br /> YOUR for Tax Exemption on Real and Persanal Proparty by�ualifying Qrganizations 45� <br /> COUNTY ASSESSOR Read instructions on reversa side. <br /> Fat�ure to properly comp(ete or file this application in a timely manner shall result in a disapproval of the exemptian. � <br /> Name nf Qrganization County County No. Type of Qwnership <br /> � � `c ��� }� q �.y)�J �.. �� `r �Nonprofit Corporation <br /> 1V <br /> Street or pther Mailing dress � 8tate Where incorporated � Other(Specity) <br /> � ��'�� � �:.���`C_�"��"'�` �w��1�f� ����.a ��� _ <br /> ���, State Zip Code Actuat Value Parcel or Location ID Number <br /> 1._"�--� `c-� t��. �l 0- <br /> Legai description of r�a1 property and general description nf all tangible pe`sonal properry,except licensed motor vehicles: � <br /> �� n`�- �-�v=� `�o�i c� 5 �tr,y s i ca� ��r� <br /> qr��s N -�1-7t o�� �v�. � ��� �d� <br /> �r�.� �.-��1 � . ___..._. <br /> Title af Officers, <br /> Name Directors,vr Partners Address,C(ty,State,Zip Cade <br /> _��c:�W�� � � ----� <br /> Properry described a4ove Is used in the following exempt category(please mark ihe appiicable boxes): m <br /> �Agr�WturaVHorticultural Society' ❑ Educational �Religious �Charitabfe ❑Cametery <br /> Give a deiaiied descriplion ot the use ot the properry: <br /> Provision of healthcare <br /> services to the community <br /> 'Agricultural/Horticultural Society does npt need to complete the follawing questions. <br /> Is ail of the properry used exclusively aS described above? �ES �Na <br /> ls a portion of the propsrty used for The sala ot alcohafic beverages? YES �NO If Yes,state the number ot hours per week <br /> is ihe praperty owned pr used by an organization which discriminates in <br /> membership or empbyment based on race,coiar,ar national orlgin? �Y�S �NO <br /> linder penalties of law,! eclare lhat I have examined this exempfion appiication and,to the best of my knowladge and beilet,it is correct anQ <br /> compleie.I also declare th i am duy authorized to sign this exemptinn applicaiion. <br /> sign � ��" C_._�� t ;�, � �1�1 <br /> here �'�thorizedSig t Title Date <br /> FQR C�UI4TY ASS�BSQH'S RECOMM�NOA7'IpN � <br /> �APPRPVAL COMM�NTS: — <br /> ❑ APPRDVAL OF A PORTIpN <br /> ❑ DISAPpROVAL � — '�W *��"�U <br /> Signatu o CouNy Assessor Date <br /> FOR CDUNTY BdA OF EQUALlZ{1TION US�QNLY <br /> 1 declare that,to the best of my knowledge and beliei,the determmation hereby made by the County Board of Equalization is Correct pursuant <br /> to the laws of the 5tate of Nebraska. <br /> � APPROVED COMMENTS: <br /> [� APPROVAL OF A POR710N � . <br /> � ;.... t� ��, s kM � v�yy . <br /> ❑ QISAPPROVED � G i���::�.�:_-. '�—,(�;� ��o�L,, <br /> �gnature oi ounty 9 a mb r te '� " <br /> Nebraska qepartment d Reveruie a' d NeU.Rev.Stat.$77-2u2.01 i <br /> 96-135-1998 Kiav,7-2070 Suparsedes 98-135-1999 Rev.11-2008 � <br /> '�L� t,�It;;� � H�`,�r"_��(�k� . <br /> PLEASE MAK�A COPY FOR YOUR RECOFinS �G�'.�,�,p9.,!�.�..;� '+ ' fti'�U�tL56CA <br />