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a-..-......° <br /> To BE Ft�EO WITH Exemption Appiication FORM <br /> vou� for7ax Exemption on Real and Personal Praperty by Qualifying Organlzatians �,51 <br /> COUNTY ASS�SSaR Read instruetions on reverse stda. <br /> F�ihare to properCy comptete or fiie this application in a timely manner shall resutt in a disapproval of the exemption. <br /> Name vi Organization Coun County No. Type oi Ownership <br /> ~`� .�„ �' c^ ` � ��, Nonprotit Cor oration <br /> :a t C...O�a.i� �,CJ C �L,1 � p <br /> Street or Other Mailing ddress �~ State Where incorporated -� �ther(Specffy) <br /> .� ��^v ` � <br /> ���� �.r �n���C.Y..��-T __.��ti�. ��:C� (�� <br /> City Stale �ip Code Acivai Value Parcel pr L.ocation ID Number <br /> L._"�-� �r� �� �lC�- <br /> Legai descripiion of reai properiy and general description pf all tanglble personal property,except licensed motor vehicles: w�� <br /> �r r_'�`- �-�.nc�S 1�.�����SS <br /> a`�,(� 19.� ��.�c���--� <br /> �.� <br /> Tit e of Officers, <br /> Name Directors,or Partners Address,City,State,�ip Code <br /> � �� <br /> Property described above is used in the following exempt category(please mark the applicabte boxes): � <br /> �AgriculturaVHorticultural Society' � Educatlonal �Religious �harilaBle �Cemetery <br /> Give a detailed description ot the use of the property: �� <br /> Provision of h�althcare <br /> services to the community <br /> "Agricultural/Morticultural Society dces nat need tn�omplete the following questions. <br /> Is all of the properiy used exclusively as described above? �-YES �NQ <br /> Is a portiqn of!he property used tor the&ale af alcbholic beverages? ❑YES �IJO I(Yes,state fhe number of hours per waek _,_,__� <br /> Is the property rnaned or usad by an organizativn which discnminates in <br /> membership or empbyment based on race,cobr,or national origin? �YES �NO <br /> Under p ties of law,i clare that I have ezamined this exemption appiicaTion and,to the best of my knowledge and belief,it is carrect and <br /> complete also lare that am dury a or'rzed to sign this exem ' applicativn, <br /> sign °� �._.:�, 1 �. �� <br /> here 'Authorized Signature Title pa�� <br /> _ OATfON � I <br /> _ FOR COLlNTY ASSESS(7R'S RECOAARAEN _ _,_,_.,__ . <br /> � APPRDVAL COMMENTS: <br /> ❑ APPRDVAL O�A PORTION <br /> ❑ C1ISAPPRQVAL c�„w���� <br /> Signature of Counry Asse Date <br /> FOH COUNTY BDARR OF EQIJAL N IJS�QNLY � <br /> I dsclare that,to the best of my knowledge and beliel,the determinatinn hereby made y lhe County Board of Equalization is cwrect pursuant ^ <br /> tp the taws of the Slate oi Nebraska. <br /> � APPROVED COMM�NTS: <br /> -:� �...- s,��,, <br /> ❑ APPROVAL DF A PORTION - <br /> �� <br /> u ,..._ . , ....... <br /> ❑ DISAPPROVED � ('j/ `� <br /> nature of Cou o ber te " <br /> Nebraska Departmenl W Revenue Authniized�by Neh.Fev:Stat �§77-202.Di <br /> 96-135-7999 Rev.7-2010 Supersedes 96•135�1999 Rev.71-2008 � � ��i`k:i'�y{'1�.7 I <br /> r`�!:,_ .�.�Y 1 <br /> r :.. '�'::i=��;��'�ia . <br /> PLEASE MAKE A CDPY FOR YOUR RECORDS <br />