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AUG-28-2012 TUE 03:33 PM GOODWILL INDUSTRIES FAX NO. 3083849231 P. 02 <br /> _a,$E-FILED WITH Exemption Application FORM <br /> YOUR forTbx Exemption on Real and Personal Property by Qualifying organizations 451 <br /> COUNTY ASSE3SDA Reed Instructions on rovereaafde. - <br /> Failure to properly complete or file this application Ina timely manner shall result in a disapproval of the exemption. i <br /> Name of Orgmlze&m county County Na. Type of Ownership <br /> .N � `I T ii ` ® Nonprofit Corporation <br /> 1!.`? r IPA Address 1� ,����' e � c �� Other(Specify) <br /> Sorel or Other M�alllrig�/A�rIeS�St / ¢ Stale Where incorporated ❑ <br /> P. a. - if,X 1O V1 .7 State Zip Code Actual Vak • P ;oar-ilia NU - <br /> CI, <br /> If A a s - A_• I 41;10!.. -• - - t I /. 1i.lise .S in <br /> Legal description of real property and general description of al tangible personal progeny;aimpt licensed motor vehi-es: <br /> N.—a, C 1-cicic Fab S (%C a.641,vist tan, xk t U*as4s 1slancelGate asSIAILI, a. <br /> \1'AO S Lt n C-ot n <br /> Carcetl\c1 fl\ancS. 1.3 La8`d02 <br /> Title of Officers, <br /> P `Name Directors,or Partners Address,City,State,Tp Code • , <br /> - <br /> Property desorbed above la used In the following°temmpt category(please mark the applicable boxes): <br /> a AgrkulardMOrticulbral Society' pi Educational ❑Religious ❑Charitable ❑Cemetery <br /> Glue a detilled decodpllon of the use of the property: <br /> Lbnc& ko dae4SA°pea Vac Wc-caL� ts-S.a_. sQ fir' <br /> (fl vs-son \oo t4. o A. a ca l s?rlocatt -S o ar C tit,-:•t\ In u-SAt tc 5 0C <br /> *Agr-Icultral/Horticultural Society does not need to complete the following questions. `- - B <br /> is all of the property used exclusively as described above? YES flf�'',,f NO !� O =" <br /> Is a portion of the property used for the sate of alcoholic beverages? f YEs lF-4 NO if yes,stem the number of hour {yepa_9 2012 <br /> is the properly owned or used by an organization which ascdminetec In HALL or employment based on race,color,or national origin? OYES ONO HALL cr; <br /> I,1../i ct.,„,, <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best of my l efant, et n Oro yertertAti <br /> complete.I also declare that I am duly authorized to sign this exemption application. -.,*J!A <br /> sign _ CFO 1,8-ate is <br /> here 'Aathedzad nature rape We <br /> I. FOR COUNTY ASSESSOR'S RECOMMENDATION 1 <br /> cA <br /> SAPPROVAL COMMENTS: ,Ifrt-rett- T7' a,©z.., <br /> ❑ APPROVAL DF A PORTION 1{ <br /> ❑ DISAPPROVAL ,SgnaMe Aaeeeaok" .Pac �M� Data a�--L-� <br /> I FOR COUNTY BOAR F EQUALIZATION USE ONLY <br /> I declare that to the best of my knowledge and ballet,the deterrin n hereby made by the County Soule of EqualizatiOn le correct pursuant <br /> iQJ j to the laws d the State of Nebraska. <br /> APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION • <br /> ❑ DISAPPROVAO Data <br /> Signature of Member <br /> Nebraska e MOWN <br /> AWwtixud by Nab At.scat.tn' .o1 <br /> e&1331 mse Ass Supereea <br /> esta•last fie+•11400e <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />