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III ILED WIT I Exemption Application FORM <br /> 'ASR for Tax Exemption on Real and Personal Property by Qualifying Organizations <br /> •'•xliir ASSESSOR P Read instructions on reverse side. <br /> y y 9 451 <br /> Failure to properly complete or file this application in a timely manner shall result in a disapproval of the exemption. <br /> ' Name of Organization County County No. Type of Ownership <br /> 0 c C&I,NJ (a115W0S bSSOL el A•t /44 j( .Nonprofit Corporation <br /> Street or Other Mailing Addres VV 11 Slate Where Incorporated ❑ Other(Specify) <br /> 13 2 "1 �Address: <br /> Slate Zip Code Actual Value Pa r o a;f ID umber <br /> I.-} to CO t,..) N P 6gS-DFS <br /> , <br /> Legal description of real property and general description of all tangible•ersonal property,except licensed motor vehicles: <br /> A <br /> I[t€ /,M 17.orkilkw_ti itmaidaen saran w///1,r trail <br /> Title of Officers, <br /> Name Directors,or Partners Address City,State,Zip Code , <br /> Segyi-f- Met";if €,(... pilxceJ-r,f- t-?) 7 1+ S'4r 1 jedfo/w NE , <br /> Joel GPO OAS Pttcidrw< k31 S kir hits kq Auc-- Mitarlcr.5 kit cri. <br /> Property de.cribed above is used in the following exempt category(please mark the applicable boxes): <br /> ❑ AgriculturaVHorticultural Society' 0-EE17cational ❑ Religious r f.❑Charitable ❑1 Cemetery, > t <br /> Give a detailed description of the use of the property: N ra s key. /jar uec4- a 1 u 4 r e OtAACCA t.O N•4 ` tty.\.& <br /> rl <br /> 1 <br /> 'Agricultural/Horticultural Society does not need to complete the following questions. <br /> ['gig <br /> Is all of the property used exclusively as described above? OYES iv <br /> L7 w - <br /> 's a portion of the property used for the sale of alcoholic beverages? ❑YES b If Yes,state the number of hours per week <br /> Is the property owned or used by an organization which discriminates in ^�1� <br /> membership:or employment based on race,color,or national origin? ❑YES [ II5 <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 <br /> complete.l also declare that I am duly authorized to sign this exemption application. <br />• <br /> sign <br /> d , 26/3 <br /> 1 — �rcr. 2 I g1 <br /> here .Authorized Signature Title Date <br /> ������//// TY <br /> FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> APPROVAL COMMENTS: ( ' ?Z"O'y, C1... <br /> ❑ APPROVAL OF A PORTION <br /> ❑ DISAPPROVAL 4 • 1 % - 3 _c9, -_11.-=4,3 <br /> Signature un Assessor Date <br /> FOR COUNTY BOAR'• F EQUALIZATION USE ONLY • <br /> I declare that,to the best of my knowledge and belief,the Marna •n hereby made by the County Board of Equalization is correct pursuant <br /> ,..t, to the laws of the State of Nebraska. <br /> 4 APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION - <br /> El DISAPPROVED !" - / "-t o w• 0/ <br /> =':nature o County Board 'em•-r III - V to <br /> Departmem of Revenue _. _. . ...a b.•as.Slat.477202.01 <br /> 16-135-1999 Rev.7-2010 Supersedes 96.135.1999 Rev.11-2008 <br /> JAN 162013 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br /> HALL COUNTY ASSESSOR <br /> GRAND ISLAND,NEBRASKA <br />