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File with Exemption Application FORM Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 Assessor Read instructions on reverse side, Failure to properly complete or timely file this application will result In a denial of the exemption. Name of Organization County Name Tax Year CHURCH OF THE NAZARENE HALL 2014 Name of Owner of Property State Where Incorporated CHURCH OF THE NAZARENE NEBR DISTRICT NEBRASKA Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 4012 N 116TH CIR $ 40002653 City State Zip Code Contact Name Phone Number OMAHA NE 68164 DANIEL W COLE 402-871-0074 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization )4 Religious Organization ❑Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code �1 Directors,or Partners IlgniWi U.rn fiole. btsrra Skra-l4 4 4011 N t I( end, f)rfAtw Ale OSIGq barr.fl W.-Ns Sec ire term ,.7395 So,-Nte'lir iier ; AE 1043Q1 lit _.. hoc T.•e , er SeoSa Si f , ;/S. i c � l ! . &842 s Lega description of real property and general description of all depreciable tangible personal property,exce• licensed motor vehi es: BOGGS AND HILL ADDITION LTS 15& 16 BLK 6(1124 N BROADWELL AVE) • Property described above is used in the following exempt category(please mark the applicable boxes): nA�1. �01¢ GggN irr4, . ' ❑Agricultural and Horticultural Society ❑ Educational 0 Religious ❑ Charitable ❑ Cemetery if 431 '' li0'S SS,fnt Give a detailed description of Ir�ee use of the property: Vq eti t3 L`>ect fvt S„429 S i ehr;5-1-,'00 eau cco-:c� and War-sh p. d�S!(q All organizations,except for an Agricultural and Horticultural 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 owner or organization making exclusive use of the property? EYES �NO is a portion of the property used for the sale of alcoholic beverages? ❑YES 00 If Yes,state the number of hours per week Is the properly owned or used by an organization which discriminates in membership or employment based on race,color, or national origin? ❑YES igiNO de enalties of law,I decl that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and col, I also declare that I a d ly uthorized to sign this exemption application. \ sign , I f1�9w_ `)ism cc 5.t�fialencod 2.22.1' here • Authorized Signature Title Date Retain a copy for your records. For County Assessor's Recommendation SApproval COMMENTS: .1 ,. ,,,.n 411' 77— , .t j a ❑ Approval of a Portion /® ,. T ❑ Denial gate,• _ was-a \ s. >` ( Signet .unty- : or Vete �` 5 :nor County B-.• of Equalization Use Only I declare that to the best of my knowledge and belief,the deter nation made by the County Board of Equalization is correct pursuant to the laws of the State of Nebraska. Approved COMMENTS: ❑ Approval of a Portion ❑ Denied b '2 6 Al- _ ,3 -as-f9 • Signature of County Board Member Date County Clerk:A legible copy of this form showing the final decision of the County Board of Equalization must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. Nebraska Department of Revenue,Property Assessment Division Authorized by Neb.Rev.Slat§§77-202.01 and 77-202.04 96.135-1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012