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TO B�FILED WITH Exemption Application �oRM <br /> YOUR fqrTax Exemption an Real and Personal Property by [�ualifying Organizations A c♦ <br /> COUN�7Y ASSES50R Read instructions on reverse side. �'fJ � <br /> Failur�to properly complete or file this application in a timely manner shall result in a disapproval of the exemption. <br /> Name of Organizatiqn County County No. Type of Ownership <br /> Sala Evangelica, Inc. Hall 40 � Nonprofit Corppration <br /> Street or Other Mailing Address State Where Incorporated � bther(Specity) <br /> 515 North Pine Nebraska <br /> City State Zip Code Actual Value Parcel or Location ID Number <br /> Grand Island NE 68801 $43,681 <br /> Legal description of real prvperty and general description of all tangible personal property,except licensed motor vehicles: <br /> The Sautherly Half (S'/�) of Lots Three (3), and Four (4) in Block Nineteen (19) in the Original Town, now <br /> City of Grand Island, H�II County, Nebraska. <br /> Title of Officers, <br /> Name Directors,nr Partners Address,City,State,Zip Code <br /> Remi'io Gonzales-Matul President 2429 North Park Grand Island NE 68803 <br /> Let Garcia Secretary-Treasurer 2429 North Park Grand Island, NE 6$803 _ <br /> � �_. � _._—--------.- ..... . . ....... ..---...--_._....._.. ...�_.------• - <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> �AgriculturaVHorticultural Society" � Educational �X Religious �Charita6le �Cemetery <br /> Give a detailed description of the use of the prpperty: <br /> The property is used exclusively as a church of worship in the Christian faith. <br /> RG�����❑ <br /> 'Agricultural/Horticuliural Society does nok need to complete the following questions. <br /> Is all of The property used exclusively as described above? �YES �NO JAN 1 S 2012 <br /> Is a portion of the property used Cor the sale of afcoholic beverages? ❑YES ❑X NO If Yes,state the number of h�AL�r�+e�,eU���� <br /> Is the property owned or used 6y an organization which discriminates in (��J <br /> membership or emplvyment based on race,color,or national origin? ❑YES ❑X N� GRAND ISLAND�����5� <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and <br /> fe.I also declare that I am duly authorized to sign this exemption applicatian. <br /> $IC��'1 G _ --;�f>'�-- President �CtrtU r �(o� ZG't�- <br /> here Aukhonze ignat Title Date <br /> FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> �APPROVAL GOMM�NTS: � ,,� <br /> ❑ APPROVAL OF A PORTION <br /> ❑ �ISAPPHOVAL <br /> Signature C nty Asses5or Date <br /> C FOR CDUNTY BOAR F EQUAL�ZATION U5E QNLY � <br /> I declare that,to the best of my knowledge and belief,the determination hereby made by the County Board of Equalizativn is correct pursuant <br /> to the laws of the Stale oi Nebraska. <br /> �PPRpVED COMMENTS: <br /> � APPRpb'AL OF A PDRTION , <br /> � DI.viAP�'ROVED ��/�/�I <br /> ignature o County Boa emb Date <br /> Nebraska Uepartnient of Rvvenue � Authorized by Neb.Rev.Stat,§77-202A1 <br /> 96-135-1999 Rev.7•201a Supersedes 96-135-1999 Rev.11-2D08 <br /> PLEASE MAK�A COPY FORYOUR RECORDS <br />