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. TO BE FILED WITH Exemption Application FORM <br /> YOUR L for Tax Exemption on Real and Personal Property by Qualifying Organizations /� <br /> • COUNTY ASSESSOR Read instructions on reverse side. 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 T y� tQ County County No. Type of Ownership <br /> Il9/ESZf �E Th�-0_5 c(3e�e Z� \ tin 1 L "C'/ ix Nonprofit Corporation <br /> Street or Other Mailing Address State Where Incorporated �} t❑N Other(Speedy) <br /> a ' T.sL A ✓e- 4D. G <br /> City O State Zip Code Actual Value Parcel or Location ID Number <br /> 0e/4AI0 . . la . 1Y. ,. .'.'o_: '_7( )5D_ D oo21) .. <br /> Legal description of real property and general de ription all tangible persona property,except licensed motor vehicles: <br /> y_ir_ f 2W t2 J -7f2 se- dy a A c <br /> 0 *eft <br /> Tide of Officers, <br /> Name Directors,or Partners Address,Ci State,Zip C•,.e <br /> _ . . A .is:' - ♦ - - // - irt" rr it .* o• <br /> e- 0 -• s raW In A. -. <br /> -- Loy ..--e• <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> ❑ Agricultural/Horticultural 111 I,5,1 <br /> ural/Horticultural Society' Educational Religious ❑ Charitable ❑ Cemetery /L_ <br /> Give a detailed description et the use of the property: . a- S. A tow ,.- ,Jc' ,t , , a V� <br /> F—r P A r--I` -. <br /> e s <br /> •Agricultural/Horticultural Society does not need to complete the following questions. AUG 8 p 0)� <br /> Is all of the properly used exclusively as described above? a' YES ❑NO <br /> Is a porton of the properly used for the sale of alcoholic beverages? ❑YES gi NO It Yes,state the number of hours per wee9k i <br /> a Is the properly owned or used by an organization which discriminates in rl ,J1 <br /> membership or employment based on race,color,or national origin? ❑YES NO C•1.. ° ,'_g • ,, -i it <br /> Under penalties of law,1 declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and <br /> complete, . • •_•. - am dul authorized to sign this exemption application. <br /> sign '.�..� �- ( ' tats y- .il2g4? <br /> here Authorized Signature Title Date <br /> `,� FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> �,[I APPROVAL COMMENTS: w w A �— 1 1 kb <br /> „.X. <br /> 0 APPROVAL OF A PORTION �`✓•'�(V}YI y <br /> ❑ DISAPPROVAL � I r <br /> ■ <br /> Signature of • ty ssessor Date <br /> FOR COUNTY BOAR r s -EQUALIZATION USE ONLY <br /> I declare that,to the best of my knowledge and belief,the determine' hereby made by the County Board of Equalization is correct pursuant <br /> to the laws of the State of Nebraska. <br /> APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION �I �/ <br /> � Al ' /S x.5 <br /> ❑ DISAPPROVED ��_ / �G7L•i---= � /- � <br /> tgnature of County Boa• ,-lt—ber Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Star.§77-202.01 <br /> 96-135-1999 Rev.7-2010 Supersedes 96-135-1999 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />