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File with Exemption Application FORM <br /> Your County `fbrTax 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 i County Name Tax Year <br /> IGLESIA MONTE SINAI INC HALL 2016 <br /> Name of Owner of Property State Where Incorporated <br /> IGLESIA MONTE SINAI INC <br /> Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number <br /> 603 E BISMARK RD $106,282.00 400091631 <br /> City Stale Zip Code Contact Name Phone Number <br /> GRAND ISLAND NE 68g0/ <br /> Type of Ownership <br /> ❑Agricultural and Horticultural Society ❑Educational Organization Cif Religious Organization ❑Charitable Organization ❑Cemetery Organization . <br /> Name Title of Officers, Address,City,State,Zip Code <br /> Directors,or Partners <br /> r/- s ♦t4 n sr O Z- 4 ' so/ <br /> II e le i, � ii ,i o> <br /> Legal desc ption of real property and general description of all depreciable tangible personal property,except censed motor vehicles: <br /> Pfo&ck\ CSC me entiire CYx)iCn , • <br /> • <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> ❑ Agricultural and Horticultural Society ❑ Educational 51 Religious ❑Charitable Milk - f <br /> Gi e a detailed description of the use of a property: -it'll'' <br /> Aic guy cavemen MAR 2 9 <br /> 2016 <br /> HALL Cit tri', c41: C i t <br /> All organizations,except for an Agricultural and Horticultural Society must complete the following questions.s.. {i`Z ftl, Ncapilisico <br /> Is all of the property used exclusively as described above? EXY ES DINI10. <br /> 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 <br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES 4 NO <br /> If Yes,slate the number of hours per week 4 <br /> Is the properly owned or used by an organization which discriminates in membership or employment based on race,color, <br /> or national origin? ❑YES '®NO <br /> 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 <br /> complete.I al-•de'e that I a duly authorized to sign this exemption application. <br /> sign , 0f=,>" f` pie-sit/00,� a3 /� <br /> Title Date <br /> here ze. .gnalure <br /> Retain a copy for your records. <br /> For County Assessor's Recomm�e(ndation <br /> Approval COMMENTS: ,.! o_ yr `�— ��t <br /> till Approval of a Portion �/� <br /> 'TT ,,,.A Ck_1 1 Cm <br /> ❑ Denial Signature o[awn - sensor - Dale <br /> For County Board .f Equalization Use Only - <br /> 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 <br /> laws of the State of Nebraska. <br /> g Approved COMMENTS: <br /> ❑ Approval of a Portion �/S, A <br /> ❑ Denied '- :t'�,1__4ns/11 J n-/�i9 <br /> •'•nature o'T.un -'1P:r, m•: ♦ Date <br /> County Clerk: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 /> Nebraska Department of Revenue.Property Assessment Dimon Authorized by Neb.Rev.Stat.§§77-202.01 and 77-202.04 <br /> 96-135-1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012 <br />