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TO BE FILED WITH Exemption Application FORM YOUR COUNTY for Tax Exemption on Real and Personal Property by Qualifying Organizations ASSESSOR Read instructions on reverse side. 45 Failure to properly complete or timely file this application will result in a denial of the exemption. Name of Organization crte4 nal County Name Tax Year DEsnNy CliuKclii AsS&instY of Con oc IS 4-4,44) j{09-2.L aD/4 Name of Owner of Properly Stale Where Incorporated Dc,>;rt/LtY GBH vg cy IVC-09 rzem KA Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Properly Parcel ID Number 644 Si 10-COS — Sr— $ Yooi37Jg3 C't State Zip Code Contact Name Phone Number N4JS24 v p ,raC 4 (/o l ye/AA ?vs I 3b0 -3 O - O p 3 , Type o wip ❑Educational Organization (►•Religious Organization ❑Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners I rice R vs 7-- Pnsroat 64417 iii. Eara 4.0 74.y jp 61Zrun h.A4,,,,9,,_ivc DitijCttr tS/4NObZ SprERr4Ttn.DCrof /sea CD- 2"D ST• cA4eva is<A<AO Air 1tee 2 G�.o3 57lvav i✓4rt</�t� agEcTax 214 Ai, (ntolFY A<s - GRi.n' isL,Q•vp yyc Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: 68o 0 3 • ujiEBF 'S /9nn trs gy-4 °r Pr trs 7Ye Xc ilEGENED FEB n2 6 2013 tt L`` G Property described above is used in the following exempt category(please mark the applicable boxes): HALL Pl(0U1N 1IIri�:ASSESSOR ❑Agn[ulturaUHOrticultural Society' ❑ Educational be Religious ❑ Charitable ❑ Cemetery GRAND ISLAND, NEBRASKA AS KA Give a detailed description of the use of the property: ASSEyxC3t`1 of Goe ° GNunc LIlt7H tvFEkLY CHvR cttyIT1Es All organizations,except for an AgriculturaVHorticultural Society,must complete the following questions. Is all of the property used exclusively as described above? ❑YES ❑NO Is the property used for financial gain or profit to either the owner or organization making exclusive use of the properly? DYES ❑NO Is a portion of the properly used for the sale of alcoholic beverages? ❑YES ❑NO If Yes,state the number of hours per week Is the property owned or used by an organization which discriminates in membership or employment based on race,color, r� or national origin? 0 YES ❑NO Under penalties of law,I declare that 1 have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete.I also declare that I am dul uthodzed to sign this exemption application. sign -.if rr•- - Pi9-s7o4 a-.2s- 13 here • Authorized Signature Title Date ��--yy FOR COUNTY ASSESSOR'S RECOMMENDATION I�1,APPROVAL COMMENTS: C"2 =1 l 1 -cZtC�1 e. ,❑`APPROVAL OF A PORTION !`� ❑ DENIAL A♦ — _ • x 1%,a -S rbi -13 Signature , •• ty Assessor Dale FOR COUNTY BOAR• •F EQUALIZATION USE ONLY I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization is correct pursuant to the laws of the State of Nebraska. VAPPROVED COMMENTS: ❑ APPROVAL OF A PORTION ' ❑ DENIED �/ i./., /L .— &./, .^ _> i_/-, /O q o I Signatu'. : County:oar !m•'r Date COUNTY CLERK: A legible copy of this form showing the nal •ecision of the County Board of Equalization must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. RETAIN A COPY FOR YOUR RECORDS. Nebraska Department el Revenue,Propety Assessment DMsion Authorized by Neb.Rey.Stet.§§77-20201 end 77-202.04 96-135-1e99 Rev.7-2012 Supersedes 96-135-1999 Rev.7-2010