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aMen ate& <br /> THIS RETURN MUST BE Tax Year <br /> FILED WITH THE COUNTY Nebraska Personal Property Return 2013 <br /> ASSESSOR ON OR BEFORE <br /> MAY 1,OR A PENALTY WILL Net Book Value County Name <br /> BE ASSESSED •Attach all supporting schedules HALL <br /> Name of Properly Owner Telephone Number Tax District <br /> LA ISLA BAR, INC (308)382-0239 <br /> Street or Other Malang Address Properly Type Precinct or Township <br /> 1710 S LOCUST ST PERSONAL <br /> City State Zip Code Legal Description <br /> GRAND ISLAND NE 68801 <br /> Address of Properly(if different than above) City State Zip Code <br /> 106E 3RD STREET GRAND ISLAND NE 68801 <br /> Totals Taxable Value <br /> 1 Commercial and industrial total(from schedule) 1 33,267 <br /> 2 Agricultural machinery and equipment total(from schedule) 2 0 <br /> 3 TOTAL TAXABLE VALUE(total of lines 1 and 2) 3 33,267 <br /> Describe any leased or consigned property in your custody,and list name and address of lessor or owner: <br /> Description of Property Name and Address of Lessor or Owner <br /> Under penalties of law,I declare that I have examined this return,including any attached schedules,and to the best of my <br /> knowledge and belief,it is correct and complete. <br /> sign ,Signature of Properly Owner Date <br /> here L MCDERMO1T&MILLER, P.C. <br /> • Signature of Preparer Other than Owner 1712/�South Locust, PO. Box X1767 Date <br /> W®gth ntyiiii lyeartE ONLY <br /> Depreciation Worksheet Reviewed <br /> Date Initials PENALTY 0 10% 0 25% <br /> Signature of County Assessor Date <br /> Nebraska Department d Revenue,Properly Assesamenl Division Authorized by Neb.Rev.Sta1.4 77.1229 <br /> 96173.1999 Rev.9.2012 Supersedes 961731999 Rev.II-2008 <br />• <br />