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�.�... <br /> 70 6E FILED WITH Exemption Application �o�M <br /> YouR forTax Exemption an Real and Personai Property by Qualifying Organizations ��.� <br /> CDUNTl'ASSESSOft qead instruotions on reverse side. <br /> Pa#fure to properfy compiete or file this application in a timely manner shalf resuit in a disapproval of the exemption. �� <br /> Name of Organizatian County County No. Type of Ownership <br /> ' �� j�C `�,� �J,�-.� �- �� � 1 �NonprofitCorporation <br /> Street pr Other Mailing ddress � State Where Incorporated � � Other(Specff» <br /> � ��:�� C� �_.�t�r�c�� ���u�� ���C°� t�.)�:n. <br /> ���y State Zip Code ACtual Value Parcel or Location ID Number <br /> L.._-f--� �� � �.. �t b- .. <br /> Legal description of re�i property and general description of all tangibte personal property,except licensed motor vehlcles: <br /> �` ��C1-� �nC�=S �`�S+I��S�p�d�� <br /> c�- (c�c� ��-�� �r�ir���� �-�1 � <br /> �r�� ��`.��c�.��e� 'C� � C.q$�C�3 <br /> Title of Officers, <br /> Name Dlrectars,or Partners Address,City,Stata,Zip Cade <br /> properry described a6ove Is ussd in ihe iollowing exempt�ategory(please mark the applica6le boxes): T � <br /> �AgnculturaUHorticultural Society' � Educational ❑Religious �t'V CharitaBfe �Cemetery <br /> .�` <br /> Give a detailed description of the use of the prvperty: <br /> Provision of healthcare <br /> services to the community <br /> 'Agricultural/Horticukural Society daes nat need to ccxnplete the following questions. <br /> Is atl oi the property used exclusively as described above? YES �NO <br /> 15 a porlion of the properiy used 1or the sa7e of ala�holic beverages? YES �Np If Yes,stale the number of hours per week __ <br /> Is the property owned or used by an organiaation which discriminates in <br /> membership or empkryment based on race,cplor,or naironal origin? �YES �Np <br /> N tlnder penalties of law,I declare that I have examined this exsmption applicatbn and,to the best ot my know{ecige and beliei,it is correct and <br /> compie#e.i so declare th I am dury authorized to sign this exemption application. <br /> Slgn � � �..�.�:� 1 ., � �._\� <br /> here '�horized ' natur Title Date <br /> FOR CpUNTY SSESSOR'S FiECOMRAEtJbAT1DN <br /> �APPROVAL COMMENTS: �� ���� �y� � <br /> ❑ APPfiOVAL OF A PORTION ' <br /> ❑ �lSAPI'FIOVAL � ���� <br /> Signatur o( ounty Assessor Date <br /> FOR COUNTY BOA F EQUAI.IZATION U5�ONLY <br /> I declare that,to the best oi my knowledge and belief,the determination hereby made by The Couniy Board of Equalization is correct pursuant <br /> to the iaws oi the State of Nebraska. <br /> � APPROVED COMMENTS: <br /> ❑ APPROVAL dF A I'dR71AN <br /> ❑ PISAPF'RQVED "'�a? �'. �� ""�� <br /> na ure at Counry m r - (�aie - -- - <br /> Na6raske Depertment of Revenue Authorlaed Net�.Rey,�a}�§77-202A� <br /> 96-135-1999 Rev.7-2010 Supersed�s g8-135-1888 Rev.11-20DB ��C �j �, L 1 � ' <br /> r � <br /> PLEASE MAKE A COPY FORYOUR RECORDS ��,��„ �;L�U1`,f`( ��vJP�uSO�i <br /> GRk!�n(�;!�,?';i.i I\eBRl�SKFh <br />