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5. 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 IGLESIA DE DIOS EVANGELICA LA VOZ PORFETICA HALL 2016 Name of Owner of Property State Where Incorporated IGLESIA DE DIOS EVANGELICA LA VOZ PORFETICA Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 1025 W 10TH ST $159,564.00 400129663 City State Zip Code Contact Name Phone Number GRAND ISLAND NE 68801 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization j( Religious Organization ❑Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,S te,Zip Code Directors,or Partners 1•ddy OhnreC 1 reccden-l- 1,t5 6 +h S+-' > 4, ejt (3 'O Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: 10595 W, Ilictix �` 0„A:130 fl rt �jlodC- ST)Lkeen Ire), to ca,ryiet,J �ar� L.O}S four C4), o,nc1 Ft. " CSC n 40 -lhc C.-1-y of GranA Ts(an d l (kit Coutti~� , r1 .ebTasa - Property described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural and Horticultural Society ❑ Educational Religious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property: i_ eifS Ar\ Se-IV-lees -1rta� Ric 1'`o-Vc dUr•tl f` kt'\c wccK On Tves��s and �j IursAo /s and sa- 1 re)al cam c)��s°@sSurlclokr( a :axe All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exclusively as described above? MAR 2.g'2016 EYES ❑NO Is the property used for financial gain or profit to either the owner or owner or organize making exclusive use toff the property? ❑YES [ tlo Is a portion of the property used for the sale of alcoholic beverages? 1 rr..I i, .,,_ :_:.PR ❑YES O If Yes,state the number of hours per week htt—L u'.) ' A-::::....?.- rl .fBr :1A3aSH Is the property owned or used by an organization which discriminates in me n Based on race,color, or national origin? ❑YES VI • Under penalties of a a•-.examined this exemption application and,to the best of my knowledge and belief,it is correct and 1 hodze•to sign this exemption application. sign Ay.r,r �,r ----Presj-elk - ` - de-/10 here , Au' •riz M'_ '•natu - , Title Date Retain a copy for your records. For County Assessor's Recommendation I Approval COMMENTS: ( ./e1_4_,Iy. ?\1(- 17- . 1 ❑ Approval of a Portion _ ❑ Denial . C _. �.._ Lk-1— t Signature o i n y • sessor Date For County Board 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. ,b{ �p Approved COMMENTS: ❑ Approval of a Portion I /../ • ❑ Denied sat/ t tfl( -] / 7/�/ 'e aur=F Co 'n-,f a •er `[fate 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