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•m.....�.y.,uca�w�s�sn reverse swe. '*'J A <br /> �fure to properfy compfefe or�Ie this appiication in a timely manner shall resuk in a disapproval of!he exemptian. <br /> Name o1 prganization Caunry nto. �- <br /> ���,►���� ype ot pwnership <br /> —�Y� �����`�� ��'� 9-.�C� ( �� n � �` �}5�NonproFit Corporatidn <br /> 6�„7� <br /> Sireet or Oiher Malling ddress � State Whero Incorporated � C?ther(Specify) <br /> _..����� C� �.-. �1 r��:� �. ��5'� <br /> __.. .. J _..���� �GC� <br /> City l 5fate Zip Code Actual Value Parcel or Location iD Number � <br /> �—'r-� `•'-1 '��-- �1�— S <br /> Legal description of raal property and general description of all tangible personal property,exoept licensed motor vahiGes: � <br /> � � �1-�- ��c_.,..:S C`�C�cc�10�-�•� <br /> ��c�.C7 ����' �cL.��c� �e� .J��/� <br /> Cf�4��.f,d ��� ���.. <br /> � Titie of�fficers, ' ' <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> � <br /> Property describad above is used in the following exempt category(please mark the applicable boxes): ° � <br /> �Agricultural/Horticultural Society• � Educational �Religious ,�Charitable �Cerrretery <br /> Oive a detailed description of the use at!he properiy: <br /> Pravision of healthcare <br /> services to the community <br /> 'Agricuttural/Horticultural Society dnes nvt need to complete the follawing questions. <br /> Is all ot the propBrty used exclusively as descrihed above7 �-YES �Np <br /> ls a portion of ihe properiy used tar the sale ot aicoltalic beverages? �YES �NO If Yes,sfate the number of hour5 per week <br /> is tha property owned or us�by an organization which discriminates in ❑ � � <br /> membershlp or employmeni base;d on race,cobr,or national origin? YES NO <br /> Under penatties ot law,I d ciare lhat I have examined this axemplion applFcafion and,to the best oi my knowiedge and belief,it is correct and <br /> compleie.I iso deGare that am duly aulhorized fo sign ihis exemption spplication. <br /> sign ti � <br /> here ��or,Z�S� C.__� _ � �-, ��1 <br /> ritle �ate <br /> FBR f;0i1NT1`ASSESSOR'S RECQRRRREfV�A77Q1Y • <br /> �APPROVAL COMMENTS: -_ <br /> ❑ APPROVAL QF A PpI�TIQN <br /> ❑ DISAPPRpVAL �_�'� �, <br /> Signatur County Assessor Date� <br /> ��^ FOR COUN7Y BOA OF�(�UAI(ZATION US��NLY <br /> I declare that,10 the best of my knowledge and belief,the determination here6y mada by the Cvunty Board of Equalization is correct pursuant <br /> to the laws ot the State of Nebraska. <br /> � APPROV�D CDMMENTS: � <br /> ❑ APPROVAL OF A PDRTION <br /> ❑ DISAPPROVED y,�" -�10 -�„i f� � � <br /> 9r <br /> nature o ounry eoar r �-= `�7ale �/ '-- �� <br /> Nabraska Oeper[ment ol Revenua <br /> 86-195-1999 qev.7-2010 Supersedes 96-135-7999 qgy.17-2009 Alrtharf29�6y He6.fiev.vRat.§77+�p2.01 <br /> DEC 2 2 ZOi1 <br /> PLEASE MAKE A COPY FOR YOUR R�CORDS �l� � ;� , f•W;�= •r�, <br /> R-�,,�..,.. �.,�. ..,;;' %�::�:�_5,��1i4 <br /> C;;�f-�'.�';�i`�:L' i,...�,,-... , �1tMt,:1i','J�'if� . <br />