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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 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. $125,000.00 400005158 City Slate Zip Code Contact Name Phone Number Grand Island NE 68801 Dana Jelinek 308-385-5510 Type of Ownership El Agricultural and Horticultural Society ❑Educational Organization [J Religious Organization ®Charitable Organization D 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 V. P. 2140 N. Park, Grand Island, NE 68803 Travis Hasselmann Treasurer 211 Ponderosa Drive, Grand Island, NE 68803 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: Original Town, Blk 62, Lot 7&8. Office building, office furniture and equipment, meeting room with tables and chairs, and office supplies.Audio visual equipment. na� Progeny described above is used in the following exempt category(please mark the applicable boxes): 0 Agricultural and Horticultural Society 0 Educational ❑ Religious ® Charitable ❑ Cemetery Give a detailed description of the use of the property: '- Office is used for the administration of Habitat's low-income housing programs, including home building:coordination and, educational programs for low-income persons. ,r 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? El YES NO Is a portion of the property used for the sale of alcoholic beverages? El YES ®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? 0 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 compl' : I also declare that l a u authorized to sign r this exemption application. sign ��y � � . > s here Authorized Signature Title Date Retain a copy for your records. For County{Assessor's yRecommendation ® Approval COMMENTS: C S.0 o . k,h - I-Tin ❑ Approval of a Portion \ m 1 ' ` ❑ Denial ' o Y�St �:``i c�-rt.- i><`1 Signatu o County Assessor Date For County Boa d of Equalization Use Only 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 / i c ❑ Denied ✓�� c5 -ignature•iounty Board Me r,e r 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.Stet.§§77-202.01 and 77-202.04 96-135-1999 Rev 1-2014 Supersedes 96-135-1999 Rev.7.2012