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� <br /> TO 6E FILED WITH Exemption Application F'ORM <br /> YOUR #or7ax Exemption on Reai and Personal Property by Glualifying Organizatians 451 <br /> COUNTY ASSESSOR Read instructions on reverse side. <br /> �aiture io properly complete or file this application in a timely manner ahall result in a disapprava!of the exemption. <br /> Name of Qrganization Co n r County No. Type of Ownership <br /> j t C l�� �_ �,� � ,L � 11 �Nonprofit Corparatian <br /> Street or Other Mailing ddress Stale Where Incorporated � dlher(Spec�ly) <br /> •_� . 1.���� L..J ����.`-'.�� �-jti.:i.� �JL �..��:�� �� � <br /> Cj�y Stete Zip Code Actual Value Parcel or Loqation ID Number <br /> 1_.-{-- �� i`� �. �10- S <br /> L.egat descriptipn of feal property and general dascription of all tangible persanal property,except licensed motor vehicles: <br /> �C1 � ��cssti �°_�� n. C.., <br /> �el\ � G� ao r y�ce- �-�- <br /> n 6�1 E ��3� _� <br /> Title of Officers, <br /> Name birectors,or Partn�rs Address,City,State,Zip Cpde <br /> _�1�-�-�c,��1r� <br /> Property described atwve is used in the following exempt category(please mark the applicabla boxes): <br /> �AgriculturaVHorticultural Society" ❑ Educational �Religious �Charitable �Cemetery <br /> Give a r�tailed description oi the use of the properry: �W��� <br /> Pravision of h�althcare <br /> services to the community <br /> 'Agricukural/Horticultural Society daes not need to complete the fo�lowing questions. <br /> Is all of the propsrty used exdusively as described above? YES �Np <br /> Is a portlon of the praperry used tor ihe sale ot akat�olic beverages? YES �hKJ If Yes,state Ihe number o(hours per week <br /> Is!he property awned or used try an oryanizatinn which discriminates in <br /> membership or ernployment based on race,color,or nafional origin7 ❑YES �NO <br /> Urder penatti�s o11aw,1 d lare ihat I have examined this e�mptio�applicatlon and,to tMe best ot my knowledge and belief,it is correct and <br /> complete o declare that I m dufy aul 'zed to sign this exemption appiiccation. <br /> sign t � i �_.:'� i �, .�� �1 <br /> here �uthorized Signat Tipe Date <br /> FOR COUNTY ASSESSdR'S R�CQMM�NOATION <br /> �APPROVAL COMM�NTS: �Y ��� '��a <br /> ���.�� _ _ --- ---- <br /> ❑ APPROVAI dF A P4RTION . � <br /> ❑ QISAPPFtOVAL <br /> Signatur of ounty Assessor Date <br /> FOR COUNTX BQA F�dUAL17J1710N US'�ONLY <br /> I declare that,to the 6est of my knowledge and belief,the determin tion hereby made by�he Gaunty Board of Equalizatlon is correct pursuant <br /> to ihe laws of tha State of Nebraska. <br /> � APPRbVEp COMM�N7S: <br /> ❑ APf'ROVAL pF A POF7TION ^'""" <br /> __-�____�r , , � <br /> �': ��� `_�; ! / <br /> ❑ DISAPPROVE� � �X���• � <br /> �gnature o Caunty 8 mb �1a� �n�� - ' <br /> r.rf+ <br /> Ne6raska Pspartment d Revenua ������ . av.3tat.§77-202.01 <br /> 86-135-1998 Feu 7-2010 Supersedes 98-735-1999 Rev.11-2008 , I <br /> ,:;C` ..C; ' <br /> C� <br /> �r�L� lo`! �a�1'r� �- E_.v..���� . <br /> PLEASE MAKE A COPY FOR YOUR RECORDS [�i,;',��`;!... 1..' 4' 6>I?,�`,E';!-� <br />