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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. q Failure to properly complete or timely file this application will result In a tidy!5 the.b(jci4lption. Na a of Oroanizati County Name Tax Year r•/fl i4-Ne ra ka Foundez-1/44, S c- /loll 20/5" Name of id- of Property /I- f- / State Where Incorgo ed , /11r4- nl ti4 ye ku rot. no(�-Icoh, 14c_ Ne6ratta, Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number alb >v t ,uei- $ ys /4't-oo City i 1 y1({ State Zip Code Contact Name Phone Number Type ns Owners fs we i 01 4 ❑Agricultural and Horticultural Society Educational Organization ❑Religious Organization ❑Charitable Organization ❑Cemetery Organization I Title of Officers, Name Directors,or Partners Address,City,State,Zlp Code t✓ai tie;n (ilnalrmktn PO lox l3e! (S-19€0,1 WE co p8No Arnold Yr •'✓i v=ce-Clva,"rrnan 3807 ad K, NeIeoa Nh 6,t9a/ Alien Ceta-K Sec/Tress 3.017 K St, Ord AIFGty62 Legal description of real property and general desc 1ption of all depreciable tangible personal property,except licensed motor vehicles: Lei-sr7 anc( SSuMrnert:e//d' �"S�•L7Les, x/ 44.4 Seth d;✓rsr�oil B/ac.k 2 iv the C,fy of &Cold rand, in AyA/� Ceai4y. Nebrafl:R (miso /den-14%e4 w14-k +he addresses or 3 Sa.S ad 3871 thrb/er RoAxi/ Cant 1s/ate1 Nehrtisk-b, 6 rke23J_ q renfrigoi 4612-134443 Property described above is used in the blowing exempt category(please mark the applicable bares): ❑Agricultural and Horticultural Society t Educational ❑ Religious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property: / /� (� J / / / �e I am hoi-tsA'7 ' -r"vv cleae/Op'nlen�"t//t/ c/13"eWiCeI C1'/'rtens. //ley To A�✓+ �"Yk M,n ,J / / / are Ira/fled an] edr-fectln Commecnit /r✓nq by Cleve/o 'nq se/ -C•cre �avrd Aousetl'eepinq t&//s. J J t All organizations,except rrddrr an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exdusivey as described above? ErYES ❑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 RNO is a portion of the property used for the sale of alcoholic beverages? ❑YES 53NO 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? ❑YES gf NO Sunder 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 cori plete.I also declare that I am duly authorized to sign this exemption application. sign 1 iamb de Celt* C Cv /z-z3-/y here Authorized Signature Title Date . Retain a copy for your records. For County Assessor's Recommendation ❑ Approval COMMENTS: i ., vv-,"y l L.,cll'L�.mk - ill- L-0_ �laa'yLC . ❑ Approval of a Portion 4,---(--• 0../ k cam_ e. ,-cLii a Denial `- { C1vn As._ 1_ r)-n- tS Sgnature o) unty Assessor Date I For County Board 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 / *Denied ,/J// . Al 4 .i :nature ofd ty"lard a •e ae 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 Net.Rev.Stet.55 77-202.01 and 77-202.04 96-135-1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012