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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 an reverse aide. Failure to properly complete or timely file this application will result in a denial of the exemption. Name of Organization County Name Tax Year Doniphan United Methodist Church Hall 2016 Name of Owner of Property State Where Incorporated Great Plains Conference of the United Methodist Church Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number P O Box 188 $134,917 400182203 City State Zip Code Contact Name Phone Number Doniphan NE 68832 Mark Haskins 402 845 2761 Type of Ownership 0 Agricultural and Horticultural Society ❑Educations Organization ®Religious Organization ❑Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Laurie Lueck Chair, Admin Comm 4030 W Rosedale Rd, Doniphan NE 68832 Dee Redman Secretary 349 Sunset Ur, Uoniphan NE 68832 Mark Haskins Treasurer 240 W Binfield Rd, Doniphan NE 68832 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: Doniphan Village Bartell Sub to the Village of Doniphan Lots 5& 6 Property Address:306 Circle Dr, Doniphan NE 68832 Property described above is used in the following exempt category(please mark the applicable boxes): 9 ,,.a ❑Agricultural and Horticultural Society ❑ Educational ® Religious ❑ Charitable ❑ Cemetery t,� c Give a detailed description of the use of the property: J U 1 V 0 1 2016 The property is used as the residence for the appointed United Methodist Minister and his/her family. HALL CO'if USSi�E GRANT lSLANci,NE6HASKA 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 maldng exclusive use of the property? YES i�i NO lea portion of the property used for the sale of alcoholic beverages? ®YES IV 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? AYES ®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 comple I also declare at I am duly a o ed to el thief exemption application. sign CHURCH TRER5UREi2 06 - of— 2016 here Authorized Signature Title Date Retain a copy for your records. For County Assessor's Recommendation igt Approval COMMENTS: C p v [�� ara *b_ ❑ Approval of a Portion ❑ Denial Signature t ty Assessor Date CK�� For County B 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. gApproved COMMENTS: ❑ Approval of a Portion S1 ❑ Denied144Mr A /�i///!� ^/ / .� re of Cou -'erg am.= e.re 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 Nab.Rev.Stat.§§77-202.01 and 77-202.04 96-135-1999 Rev.1-2014 Supersedes 96-195-1990 Rev.7.2012