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THIS RETURN MUST BE Tax Year <br /> FILED WITH THE COUNTY Nebraska Personal Property Return 2013 <br /> ASSESSOR ON OR BEFORE Net Book Value Count'Name <br /> MAY 1,OR A PENALTY WILL <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 Maiing Address Property 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(x[afferent Than above) City Slate Zip Code <br /> 103E 3RD ST GRAND ISLAND NE 68801 <br /> Totals Taxable Value 1 <br /> 1 Commercial and industrial total(from schedule) 1 2,679 <br /> 2 Agricultural machinery and equipment total(from schedule) 2 <br /> 3 TOTAL TAXABLE VALUE(total of lines 1 and 2) 3 2,679 <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 <br /> Signature of Property Owner MCDERMDTT& MILLER, PC. Dale <br /> here P.D. Box 1767 04/29/13 <br /> Signature dl Preparer Other than Owner GRAND ISLAND, NE 68802 47-0608676 Date <br /> FOR COUNTY ASSESSOR'S USE ONLY <br /> Deprecation Worksheet Reviewed <br /> Date Initials PENALTY ❑ 10% 025% <br /> 11 Signature of County Assessor Dale <br /> Nebraska Department el Revenue,Property Asseasmem Division Authorized by Neb.Rev.Sta1.a 77-1229 <br /> 96173-1999 Rev.42012 Supersedes 94173-1999 Rev.11-2008 <br />