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TO BE FILED WITH I Exemption Application FORM <br /> YOUR COUNTY f for Tax Exemption on Real and Personal Property by Qualifying Organizations <br /> 451 Read instructions on reverse side. <br /> I Failure to properly complete or timely tile this application will result in a denial of the exemption. I <br /> Name of Organization County Name Tax Year t <br /> Church e.4. (✓'ca o-4 ^prey ha c(. rt0IL ,dt p f <br /> Li- <br /> Name h Owner of Property el cal 1 Slate Where hlct/Cletl <br /> C LA i h 4 6.p J r op hoc /NV/ <br /> Street or Other Mailing Address of Applicant a Total Actual Value of Real and Personal Property Parcel ID Number <br /> t6,2o Ni Brocc-du/e/1 $ K4i q31 oa Hie 73 <br /> City State Z' Code <br /> Zip Contact Name Phone Number <br /> CriarJ ci r Sian cJ NG ecgv3 George. /V. Jones ( o8 3S'o-!330 <br /> Type of Ownership O �/ <br /> ❑Educational Organization g eligious Organization QCharitabte organization 3lo .1381- 35. �fT <br /> ❑Cemetery gemzation <br /> Name Title of Officers, <br /> Directors,or Partners Address,City,State,Zip Code <br /> Georg N Jones ?cc., rote. /P g aye 1./lieu/ Cr. * /I. <br /> J &e--euiLd .Cs /:al/d Ai fi £r <br /> b l oa <br /> Legal description of real property and general description of at depreciable tangible personal property,except licensed motor vehicles: <br /> wet La-wit t'c fh& City c 4 6 rand .siard L7' I/r <br /> -: <br /> Property described above is used Si the following exempt category(please mark the applicable bares): <br /> AgricNethl <br /> raorticutlus ,- / <br /> l Society' 0 Educational r�RebgiouS ❑Charitable 0 Cemetery 5 F P 2 4 2013 <br /> Give a detailed description of the use of the property: <br /> 1 {-s o nr, €k5e_, <br /> All organizations,except for an AgricullurabHorticultural Society.must complete the following questions. <br /> Is at of the property used exclusively as deserted above, EYES D/NO <br /> Is the property used for financial gain or profit to either the owne or organization making exclusive use of the properly? n YES rvNO <br /> u <br /> Is a portion of the property used for the sale of alcoholic beverages? DYES No <br /> II Yes.stale the number of hours per week <br /> is the properly owned or used by an organization with discriminates in membership or employment based on race.color, <br /> or national origin? ❑YES [a NO <br /> Under penalties of law,I declare that I have examined this exemption application and to the best of <br /> complete.I also(recta t tram duly authorized to sign this exemption application- inY knowledge and belief,N is correct and <br /> sign ?as-be r o9 .74, /3 <br /> here Audwrized nature Title Date <br /> FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> APPROVAL COMMENTS: _ r C e� g,,v-y.a-yp'� 77- c 1L <br /> O APPROVAL OF A PORTION < `� <br /> Q DENIAL ta . _ • % � __1 <br /> art Assessor Date <br /> ro <br /> I. FOR COUNTY SOAfl' •F EQUALIZATION USE ONLY <br /> I declare that to the best of my knowledge and beliel,the determination made by the County Board of Equalization is correct pursuant to the <br /> laws of the State of Nebraska. <br /> �./' <br /> U(L APPROVED COMMENTS: <br /> O APPROVAL OF A PORTION ,�j� <br /> ❑ DENIED , /ire At r /'2J rj'Q/L/ <br /> Signature of County Board Member Date 7 <br /> COUNTY CLERK:A legible copy of this form showing the final decision of the County Board of Equalization <br /> must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. <br /> RETAIN A COPY FOR YOUR RECORDS. <br /> Nebraska Departmental Revenue.Propety Assessment Demon Authorised by Nab Rev.Slat.66 77-202.01 and 77-202.00 <br /> 96.1351999 Rev.7-2012 Supersedes 96.135.1999 Rev.7-2010 <br />