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File with I , Exemption Application FORM Your County foflax 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 BEREAN FUNDAMENTAL CHURCH OF GRAND ISLAND HALL 2016 Name of Owner of Property State Where Incorporated BEREAN FUNDAMENTAL CHURCH OF GRAND ISLAND NEBRASKA Street or Other Mailing Address of Applicant - Total Actual Value of Real and Personal Property Parcel ID Number 4116 W CAPITAL AVE $877,294.00 400149672 City State Zip Code Contact Name Qp i^) Cr_LIki - Phone Number GRAND ISLAND NE 68803 6GG T r9 c 398-880=5196 3D$-381-788y Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ®Religious Organization ❑Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Legal description of real property and general description of all depreciable tangible personal property,except licensed motor ve F ¢.w....� BEREAN BIBLE CHURCH SUB TO THE CITY OF GRAND ISLAND LT 1 L v g--. APR 182016 HALL CO Properly described above is used in the following exempt category(please mark the applicable boxes): r ❑ Agricultural and Horticultural Society ❑ Educational igsReligious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property: All organizations,except for an Agricultural and Horticultural Society,mat complete the following questions. - Is all of the property used exclusively as described above? BYES ❑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 N.NO Is a portion of the property used for the sale of alcoholic beverages? DYES NO If Yes,state tfie 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 NNO 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 comp�)°e.I also declare that I am duly authorized to sign this exemption application. sign K Vot„k1. AL Cliek here AuthorizedS nature Title Date Retain a copy for your records. ��--�z{�'' For County Assessor's Recommendation Approval COMMENTS: e_f_d_ 'l 4 ( t r a /❑"Approval of a Portion \ ❑ Denial "� -. _ - ...,��_ Signature..kou ty•s ssor Date For County Boar; of Equalization Use Only 1 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 o1 Nebraska. I�t Approved COMMENTS: ❑ Approval of a Portion ❑ Denied 174 ✓� , / ‘37716 _:.'atun of Count .. 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 Division Authorized by Neb.Rev.Stet.§§77-202.01 and 77-202.04 96-135-1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012