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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. Failure to properly complete or timely file this application will result in a denial of the exemption. Name of Organization County Name Tax Year Platte River Whooping Crane Maintenance Trust, Inc. Hall 2016 Name of Owner of Properly State Where Incorporated Platte River Whooping Crane Maintenance Trust, Inc. Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Properly Parcel ID Number 6611 Whooping Crane Drive $31,642.00 400311046 City State Zip Code Contact Name Phone Number Wood River NE 68883 Charles A. Cooper (308)384-4633 x 116 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization ®Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Van E. Korell Chairman AmFirst Bank, N.A..602 W. "B"St.. McCook, NE 69001 Thomas J. Dougherty Vice Chair 2973 Zachery Drive, Loveland, CO 80537 Douglas L. Curry Secretary/Treasurer Erickson &Sederstrom PC LLO, 301 S. 13th St..#400, Lincoln NE 68508 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: The legal description for this real property is 6611 W. Whooping Crane Drive, Wood River, NE 68883-9554. Its parcel number is 400311046.The said real property is a building,which is surrounded by land.The surrounding land is identified under parcel number 400218917, which has a legal description of ALDA TWP SW 1/4 SE 1/4 32-10-10. The attached Exhibit"A" contains a general description of the tangible personal property located at parcel numbers 4003110 d 4002189ep17. � Property described above is used in the following exempt category(please mark the applicable boxes): N a feb ❑Agricultural and Horticultural Society ® Educational ❑ Religious ® Charitable ❑ Cemetery / g Give a detailed description of the use of the property: DE" d 1 2015 The Platte River Whooping Crane Maintenance Trust, Inc.("Crane Trust")is a charitable organization dedic. E al • r-rii.- • and - maintaining critical habitat for Whooping Cranes,Sandhill Cranes,and other migratory birds.The Crane Tr ' • -1 I, : +r'fiyp9 exclusively for this purpose and for related charitable,educational,and scientific purposes.The said property is exe 't,1 r Neb.Rev.Stat.§77-202(1)(d), among other reasons. A$KA All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exclusively as described above? ®YES ❑NO Is the property used for financial gain or profit to either the owner or owner or organization making exclusive use of the properly? ❑YES ®NO Is a portion of the properly used for the sale of alcoholic beverages? ❑YES ®NO 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? 0 YES El NO Under pens s o 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 at re that I a duly a orized to sign this exemption application. sign 7 //� Z�� President and CEO 12/30/2015 here Authon 'gnat e G Title Date Retain a copy for your records. ��((( For County Assessor's Recommendation Ij5( Approval COMMENTS: —CT"cZ.c` r-_ • /❑,Approval of a Portion + (�(� D Denial Il \ A�RAJ r'3�L.< <_. Date pl A-1.Sr-, Signature cif unit'Assessor Date I 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 z laws of the State of Nebraska. tit Approved COMMENTS: ❑ Approval of a Portion / 1 / ❑ Denied l /1 i/ �17-/6j gnat • '."'•ard emb' Dale 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