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To g������W�T� Exemption Application �o�M <br /> You� � forTax Ex�mption on R��1 and Personal Property by Qualifying Organizations ^�� <br /> GQUNTY ASSESSC)R; Read instructians an reverse side. `"r <br /> Faifure to properly cnmpleY�or file this application in a timely rrianner shali result in a disapproval of the exemption. <br /> m � ..._._ _._..�._..�.__�._..............�_....�._w.....�._...� <br /> Name nf Organization i County County No. j iype of Qwnership <br /> Nebraska Specialty Network LLC pBA Nebraska Heart Institute ! Hall 40 ; � Nonprofit Gurppration <br /> Street or Other Mailing Address � �5tate Whare Incorporated � 01her(Spe:cify) <br /> 7440 South 91 st Street j Nebraska ' __.�__._. _.___.._____ <br /> City � ����� � �� �m State ���� Zip Code Actual Value ���� �� —�Parcel or Location ID Numbcr � <br /> Lincoln NE 68526 � $0 j �Q� <br /> Legel description ni rc�al prnporty and general descriptlon of all tangibie personal property,except licensed motor vehic�ids� �/�����--•/ <br /> �.�� , <br /> Medical affice e qui pment and furniture � <br /> ��J��J �,�C��4I2GL� <br /> W� Title nf Officers, �---_ <br /> Name Dlrectors,ar Partners Address,City,State,Zip Code <br /> Dr. Kent Reckwwe � � CEO 8055 O Street Ste 300 Lincoln NE Fi8510,_ __�,,,, � <br /> Alan Uden GF� ,8055 a 5treet Ste 300, Lincoln NE 68510 <br /> Mi.�.h�el Ronnin ��mm CAO ���8055 O Street Ste 300 Lincoln NE 68510 WY�W��~_ � <br /> Terrv RoQers ��� �8055 O Street 5te 300 Lincoln NE 6851a <br /> .�.....�..�.._..._......___ _�.... __�.._ _. <br /> Property described above is used in the fallawing exempt cnlegory(please mark ihe applicable boxes): <br /> �Agricultural/Horticultural Sociefy' � Educational ❑Reliyious �Charitable �Cemetery <br /> �...__.._.__.............�.�. ._��_�. ��_.�___ ------.._._..........�..�....�.....�..�........_�,�.... <br /> Give a detailed description of tha use of the property: <br /> Improving the cardiac, vascular and thoracic health of the people the cammunities we serve. <br /> Initiatives: Pioneering models and systems of care to enhance care delivery. <br /> 'Agricultural/Hvrticultural Society dcses not need to complete the following questions. � <br /> Is all of the prnpsrty used exclusively as d�rscribed above? �YES �NO <br /> Is a portion ot the property usocl tor the sate of alcoholic be�eragas? �YES �NO I(Yes,state the number ol hours per weok ,.....,�.T <br /> Is the prnperty owned or used by an organization which discriminates in <br /> memlaership or employmeni based on race,color,or national origin? �YE5 ❑X NO <br /> �_� ._ _.�.�.�_� ........... <br /> Under penalties of law,I declare tnaT I have examined this exemption application and,to the best of my knowledge and belief,it is correct and <br /> complete.I also declare t uthorized to sign this tion application. <br /> � <br /> ��g V.P.of Finance �Z'N` �� <br /> h��.Cy Auihorized Signature Title [7ate <br /> AA 4 <br /> � � FOR COUNTY A55ESSOR'5 RECOMMENDATI�N � W�y W...._ �W�-.��mmT� <br /> � A!'PROVAI. COMM�NTS: �� �`�.— r'1� .� <br /> ❑ APPROVAL OF A F'ORTION „W,_ .__._....�.,.. <br /> ❑ DISAPPROVAL �� �--- _ • ��.+a+—� <br /> � Signatu County Assessor Date <br /> FOR CC)UNTX BO OF EpUALIZATION USE ONLY � � <br /> I cleclare that,to the best of my knowled�e and belief,the detor nation hereby made by the County 8oard ot�qualization is corract pursuant <br /> to the laws of the State ot Nebraska. <br /> � APPROV�I] COMMEN75: _^ �__�. �....__ <br /> � � <br /> ❑ APPRQVAL OF A F'OR710N _._.��..__ <br /> n p15Af'PROVED ��W'_ ��� -�-�l� <br /> 9ignature ot County eoar m r Oate <br /> NaCraska Oepartrnent of Re�enue f ��E� � � Au�h�r.acd hy Neh.Rev.Sra�.§7;�zL2.Lt � <br /> t�6-Y35-1999 Rev,7-?.01Q Supersedes 96-135-1999 F�ev.11-2006 . . <br /> ����. L��r�9��Y �i���w�0�i <br /> PLEAS�MAKE A C�PY FOR YOUR REC��r�^���� 9V�:BRASKA <br />