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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 ofc9rgio nizaaon County Name . TaxYear Co11ac Chin " IialI - 2019 Name of Owaer of Property i State Where)ncorporated C011R,t% Czar `l (V L Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 3001 1-vS 56-i00 $ C , a 0 4 . City U State Zip Code -t Co ct Name r Phone Number (� '1 QQy Witt it) 19 tV1 ! bay I. � olcovi lea"?36-ga { iJ Type of Ownership ❑Agricultural and Horticultural Society Ii Educational Organization / Religious Organization �,C,Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code y � 'Mn, rectors,or Partners /� r 01 At ick V0 f—e5 _ 'A 45 9acl Ili NN�C K<arvv-y �� E if, S'015 Jolt-t &Pi+-ok iJItO i31 PIJIFt Ufew Are ' Phi11ttf NE bSSbs 7 Jnvak Lute 5.ec. 1114 t. 474h ,SJ-w/- 'In.u2 }.sari. .., 41L &8847 Legal description of real property and general description of all depreciable t(),--1 n ble personal property,except licenped motor vehicles: J! lAi1-vn 70Cttw1 tMcxcki Vat 4 Oavi0U5 O C.9 .e[ttit pme� 014 2 o6;c.,¢ 4tA-rniSL4 v _v Property described above is used in the following exempt category(please mark the applicable boxes): ❑Agricultural and Horticultural Society i ggqqq) Educational prReligious 14 Charitable ❑ Cemetery Give a detailed description of the use of the property, (A)A. ct5Sr)'E uotr1 AA av,U +couW1°5 (t0.ctw/ uu.z,ireckeel 1%J c 1Acrne5r 53-vt. t- 5 v t-k pCS' - �f-eetg aka i ct`5te5 ai..$eR &5tJ IAwodk t55tUU.u. U1) tic +His b,„1. pytiy:( hM { pwJytaakc� _t 45.1_5",„ ItiMt 0 0B iktkretseta.45 , j; ,a-ri .4 t IA ict4 'wit U 174-itk 5'fi set`-adytrv, . 4l.,caI-w4.2.44_ 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 theproperty? DYES ❑NO Is a portion of the property used for the sale of alcoholic beverages? DYES ❑NO If Yes,state the number of hours per week Is the property owned or used by an organization which discriminates in membership or employment based on race,color, or national origin? DYES ONO Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete.I also dec that I am duly authorized to sign this exemption application. sign (at/ f4y s zl iu here Authorizekl Signature Title Date Retain a copy for your records. For County -+Assessor's Recommendation T X Approval COMMENTS: ivy, e 1r 1'7- ..cm c ❑ Approval of a Portion R 7/9_, ❑ Denial ♦ w �i / t -_�` i�@,/, -, `sY�ilct !* Sign- aunty' sessor Date I For County B':rd of Equalization Use Only MAY 1 2014 I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization is py -q4 Ryr gbf�(hy SSES,SOR laws of the State of Nebraska. r1NLL ULJUIV 1' H Approved COMMENTS: GRAND ISLAND, NEBRASKA ❑ Approval of a Portion e 0 Denied !la / // c 47 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,Properly Assessment Division Authorized by Neb.Rev.Stet.§§77-202.01 and??-2.02.04 96-135-1990 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012