Laserfiche WebLink
Dec. 19. 2014 2:31PM SAINT FRANCIS MEDICAL CENTER No. 0101 P. 2 <br /> Flewith Exemption Application ! FORM <br /> Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 <br /> Assessor Read instructions on reverse side. <br /> Failure to properly complete or timely file this application will result In a denial of the exemption. <br /> Name of Organization County Name TaxYOaf <br /> SAINT FRANCIS MEDICAL.CENTER HALL 2015 <br /> Name at Owner W Properly Stale Where Incorporated <br /> SAINT FRANCIS MEDICAL CENTER NEBRASKA <br /> Street or Other Mailing Address ofAppfcant Trial Actual Value 01 Real and Personal Property Parcel lD Number <br /> PO BOX 9804-2620 W FAIDLEY AVE $70,909.00 SEE ATTACHED <br /> O0y Stele Zip Code Contact Name Phone Number <br /> GRAND ISLAND NE 68802 ELLIE PLAMBECK 308-398-5405 <br /> Type of Ownership <br /> ❑Agricuanal and HorrculWrel Sagely ❑Eduoaional Orgenpabon [Relglous Orgaaiaakel ❑Charitable Orpnizelion ❑Cemetery organization <br /> Name <br /> Title of Officers, <br /> Autos%City,State,Tap Code <br /> parts <br /> Dlreclora,or Partners <br /> Cliff A. Robertson.MD CEO-CHI Health 12809 West Dodge Road;Suite 368, Omaha,NE 68154 <br /> See attached <br /> Legal description al reel property end general descrpton of all depreciable lengpke personal property,eaept roensed motor vehicles: <br /> See attached listing • <br /> DEC 19 2014 <br /> Property der/abed above Is used In me foltaaeg exempt category(p'eee meta the eppltaae berms): (�};-:.,` <br /> o Aglculural and Horticultural Society ❑ Educational Relarous ❑Cherieble ❑ Gamely <br /> Give a detailed description of to use of the properly: <br /> Garages used for facility vehicles and maintenance <br /> Al organizations,except for an Agricultural and Harboxlmrel Society,must complete the following questions. 1��r <br /> Is at of the property used exclusively as describes above? b <br /> above? l YES ❑NO <br /> le the properly used for financial gale orprolate either the awner or owner or organasettOn mating eaduslve use Cl the Pronely? ❑YES ®NO <br /> Is a potion of the property used for the eels el alceholb beverages? QYES tvplc <br /> If Yes,slate the number d han per week <br /> IS the property Owned Or treed by On organization with dbaimietee in memberehlp or employment Wed on race,calor, <br /> or national orgta? • OYES NO <br /> Under penatres of law,I deter inel I here examined this anrripl'on epprcaron and,to the heat al my knowledge and belief,It la correol end <br /> complete.I also declare I em <br /> SWy o align Nta erempaon application. <br /> sign Y. ( � <br /> VP kb.a44 AD_ /.Z —19 lam/ <br /> here Aahorirad54eose lire <br /> Retain a copy for your records. <br /> For County Assessor's Recommendation <br /> Fa Approval COMMENTS; /C1.7Ca rn. V 71— <br /> ❑ Approval of a Portion <br /> ❑ Denial A t , e . _ ' !al.'_ a- <br /> Signature• ••only Assessor Date <br /> For county Board of Equalization Use Only <br /> I declare that to the best of my Knowledge and beret,the determination made by the County Board of Egtaleatron is correct pursuant to the <br /> knee of the Slate of Nebraska. <br /> ❑ APProvad COMMENTS: <br /> ❑ Approval of a Portion '// <br /> ❑ Denied e. Cavil al-.7 4,AS <br /> ,t.,a !o r•�, . .,�m _mb.� i/ Dale <br /> County Clark 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 /> Neeraara oapaama'of Mauve,mopenyMwament oleos A,rNAhsdlw Nea Rene ego.847 402.01 end 71.102.04 <br /> eS-lSa-lSOa en 52014 Supersedes ab4e9-1999 M.7012 <br />