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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 Grand Island Area Habitat for Humanity, Inc Hall 2014 Name of Owner of Property State Where Incorporated Y• Grand Island Area Habitat for Humanity, Inc. NE Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 502 W. 2nd St. $20,000.00 400430525 City State Zip Code Contact Name Phone Number Grand Island NE 68801 Dana Jelinek 308-385-5510 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization ®Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Jeremy Reimers President 1013 E. Phoenix, Grand Island, NE 68801 Julie Markvicka VP 2140 N. Park, Grand Island, NE 68803 Travis Hasselmann Treasurer 211 Ponderosa. Grand Island, NE 68803 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: MISCELLANEOUS TRACTS 10-11-9 PT NE 1/4 SW 1/4 SOUTH OF EAST 8TH ST&WEST OF TAFT 1.73 AC oRt L Property described above is used in the following exempt category(please mark the applica a boxes): ❑ Agricultural and Horticultural Society ❑ Educational ❑ Religious f i Charitable ❑ Cemetery "" '- Give a detailed description of the use of the property: � ' " - :>. Vacant property which will be developed into six lots on which six Habitat homes will be built. s All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. - GI ir,I7G lye - z- Is allot 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? ❑YES NO Is a portion of the property used for the sale of alcoholic beverages? - ❑YES is NO It 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? ❑YES ®NO 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 ale- '-eclare that I am duly authorized to sign this exemption application. sign ' air ' ,t% X ED - rz/s/i I here I Authorized Signature Title Date Retain a copy for your records. For County Assessor's Recommendation r; n 7 'Approval COMMENTS: - CW ': 'nit? 4 Z- ac-_, a ❑ Approval of a Portion ❑ Denial \ re f unt.s Assessor Cr x9..�i� Z- I.� I Signature f unty Assessor to I For County Boar of Equalization Use Only I I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization is correct pursuant to the laws of the State of Nebraska. ❑ Approved COMMENTS: ❑ Approval of a Portion �, / n /' ❑ Denied ✓/ !—�1N. /// oC –02-4'�S Sn ature 7 %:u ••�'•.w - 'bet. 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