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TO BE FILED WITH pp nRILk"H <br /> Exem tion A lication <br /> Exemption <br /> YOUR for Tax Exemption on Real and Personal Property by Qualifying Organizations /� <br /> COUNTY ASSESSOR Read instructions on reverse side. 45 <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 ,/J]� // r 1 County County No. Type of Ownership <br /> -4-tijfe5 -4 0 vans,/1%,-.61 ?e'it d1 /1 Jr�0v4 �'S67 A%� is Nonprofit Corporation <br /> Street or Other mailing Addre MLL V� State Where Incorporated ❑ Other(Specify) <br /> /alas & 44.3/. . /UC'6 dasK4_ <br /> City /� State Zip Code Actu Value Parcel or Location ID Number <br /> 1:76-em r-�lq�r�, /Yd elev ! 5D, opt? ,o sDDD3-27/,2 <br /> Legal description oo eal prope`t g eral 9escription of II tangible personal properlyy'e`c pt licensed for vehicles' <br /> larnAtd atd-k ,Wc a; Vi e, c'wgnc ..7-2'/®o I S 4 d OLe- IS <br /> .me-s4-' aoq Pe LUf, 5>4Y2, I Lea, QP,nq s,C"' <br /> Title of Officers, <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> ' y Si .4 , 'no , el �2�0��tv��/)n-a-c As G,!-- a 'w & 6,� <br /> x , 9 p ', 'c a fiat•• �ae.i' rlFJtA©'�s , S , . • <br /> r0 . 1P -n-1 " G .a .f/qn.- & e <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> ❑Agricultural/Horticultural Society` ❑ Educational g Religious ❑ Charitable ❑ Cemetery <br /> Give a detailed description ol the use of the property: eke"aal , <br /> 'AgriculturaVHorticuttural Society does not need to complete the t" <br /> following questions. <br /> g <br /> Y� <br /> Is all of the property used exclusively as described above? YES ❑NO <br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES '�NO If Yes,state the number of hours p'er week , <br /> Is the property owned or used by an organization which discriminates in .. <br /> membership or employment based on race,color,or national origin? ❑YES pNO <br /> Under penalties of law,I declare that I have examined this exemption application and,to the best ol my knowledge and belief,it is correct and <br /> complete.I yto declare that m duly authorized to sign this exemption application. - <br /> sign _ ��5 %�/i94� <br /> ere Authorized Signatur -- - — Title Date <br /> ,��y//,,, <br /> / FOR COUNTYY ASSESSOR'S RECOMMENDATION <br /> APPROVAL r' COMMENTS: L /[per O 1 i )R <br /> ❑ APPROVAL OF A PORTION —l— ` i <br /> ❑ DISAPPROVAL �k .., _ i ' % yam, __ 1— t�1* <br /> Signature—6 i Assessor Date <br /> FOR COUNTY BOAR' EQUALIZATION USE ONLY <br /> I declare that,to the best of my knowledge and belief,the determine, hereby made by the County Board ol Equalization Is correct pursuant <br /> to the laws of the State of Nebraska. <br /> WAPPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION <br /> ❑ DISAPPROVED , /O,O u r + /" �— 1%078�Kw1/T e <br /> Signature of County Board Member Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stal.§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 />