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TO E FILED WITH Exemption Application FORM <br /> YOUR for Tax Exemption on Real and Personal Property by Qualifying Organizations <br /> LINTY ASSESSOR P FOR <br /> Read Instructions on reverse side. <br /> F <br /> 451 <br /> ailure to properly complete or file this application in a timely manner shall result in a disapproval of the exemption. <br /> Name of Org County N t/ / County i o. Ty e of Ownership <br /> C /t(�[(((/ V Nonprofit Corporation <br /> Street or Oth rMa Ad���ggs � o Stale Who IncorppF�ated ❑ Other(Specify) <br /> ad/ E s0a Fro,sic nuke, <br /> Ci State Zip Code Actual Value Parcel or Location ID Number <br /> et& i IS/•vi , e' <br /> ,# 1 J <br /> Legal description of nal property and ge eral de ri•tion of all tangible personal properly,except IicensesLmotor v icles: <br /> fee" ..u.; .,av r- _ ?od Gke.e/ /CJ/C131 , .,1 /03 <br /> / <br /> Title of Officers, <br /> Name Directors,o Partners Atltlress . <br /> Address,City,State,ZI• Code <br /> I/It iiii,M=2111.1treflicLaParRfAnWelrirrei Int ire <br /> T! W/M r tie Fr. t, " r- :r/e, Gr, , ,_i i t ;'193 <br /> it_ iMiraMOMINWK' T'T�L' LAW-ae G AS' _ <br /> i t .- 0" r ri'�3 ,at1 <br /> Property described above is used in the fallowing exempt category(please mark the applicade boxes): <br /> ❑ Agricultural/Horticultural Society' ❑ Educational ❑ Religious Ip yharrtable ❑ Cemetery <br /> Give a detailed description of the use of the property: = • <br /> ���ro , • � � '. , ..e 9` i use SLr. i. <br /> _. - r tr - _✓-.1' of-.. �/' � .,�/I' , tor s r r; <br /> Ca use C2 /r at T Sian • t a <br /> •AgriculturaVHorticultural Society does not need to complete the following questions. <br /> Is all of the property used exclusively as described above? igt YES ❑NO <br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES j10 If Yes,state the number of hours per week <br /> Is the property owned ur used by an organization which discriminates in <br /> membership or employment based on race,color,or national origin? ❑YES PIRO <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 j <br /> complete.I also declare that I am duly authorized to sign this exemption application. I <br /> i <br /> here ,Authorized Signature Title <br /> Ras;h Plf l�</7C ,°' !— 7—241 Date <br /> ,,..( FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> „A APPROVAL COMMENTS: 4 -74p 7 - <br /> ❑ APPROVAL OF A PORTION (, <br /> ❑ DISAPPROVAL ' � <br /> Signature ou y saes V_V ` <br /> 1 Date <br /> FOR COUNTY BOARD F EQUALIZATION USE ONLY <br /> I declare that,to the best of my knowledge and belief,the determinati hereby made by the County Board of Equalization is correct pursuant <br /> to The laws of the Stale of Nebraska. <br /> 9111.,APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION aft. ow <br /> / - <br /> ❑ DISAPPROVED - <<iJ% - II ,-`��- L <br /> -ignature 0 County Boar. ems-r Date <br /> Nebraska Department ofResnue <br /> Date <br /> 96.135-1999 Rev.2-2010 Supersedes e6-135-1998 Rev.11-2008 *k eep oe.Stat.§77-202.01 3 <br /> HALL PLEASE MAKE A COPY FOR YOUR RECORDS uil 1;i1A� E <br />