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' TO BE FILED WITH Exemption Application FORM <br /> YOUR for Tax Exemption on Real and Personal Property by Qualifying Organizations <br /> UNTY 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 County County No. Ty of Ownership <br /> in_1D^O p`OS t!s ilyo '>t of kNonprofit Corporation <br /> Street or Other Mailing Address.' V� ,id State Where incorporated �Y ❑'Other(Specify) <br /> 12-3 State Zip Code Aclu Par =I•r •cation ID Nun•- 1 <br /> 6i(a",�rri♦," islar>i NE <br /> ani ( I �1r_re� l/G1D <br /> Legal rI�ry�',qQ,jI1 rea epaQlWpdyenGa CC-�'pl pll to ral prop�rty'eltc��Ij,ens-• •• icle. I�/�I/IVI II 11 Il.7r/J W (� OaJ1 <br /> aJ <br /> Title of Officers, <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> LA M :r rTMEIr+ l --G ' i SIG v .0 t' 'oft) m mo Tr ' • <br /> 110 i •• h SS+. T ► tyf- s <br /> .a.. .` _v z ..,;( .s. :ifti iv • 1':_a•r� • -'AA it ref L/ , . e AS - <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> ❑ Agricultural/Horticultural Society' ❑ Educational Religious ❑Charitable ❑ Cemetery <br /> Give a detailed description of the use of the property: "• • 4b, t -fit_ 'j , i•.'_: ii (ate A & It 0 •fsAC <br /> peOpte in OviWCUnit l • <br /> 'AgriculturaVHorticultural Society does not need to complete the following questions. <br /> Is all of the property used exclusively as described above? ES ❑ NO. <br /> Is a portion of the property used for the sale of alcoholic beverages? YES. n NO If Yes,state the number of hours per week <br /> Is the property owned or used by an organization which discriminates in l <br /> membership or employment based on race,color,or national origin? ❑YES yCk3 N0 <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.I a�ectare that I am duly authorized to sign this exemption application. <br /> sign �-` fres,des// `�rs747 /2 5O 47 <br /> here Autorized Signature Title Date <br /> I' FOR COUNTY ASSESSORS RECOMMENDATION <br /> S.APPROVAL COMMENTS: P 94+' \\\_ y- et- e?'-' 0'a <br /> ❑ APPROVAL OF A PORTION <br /> ❑ DISAPPROVAL • O. - • •S _ ` \_at4- L-2, <br /> . Signature of Co . -essor Date <br /> FOR COUNTY BOARD O •UALIZATION USE ONLY <br /> I declare that,to the best of my knowledge and belief,the deferminato ereby made by the County Board of Equalization is correct pursuant <br /> �-, <br /> to the laws of the State of Nebraska. <br /> k APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION <br /> ' kd o1 o,Ci❑ DISAPPROVED �- !'icl�� /% <br />