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