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TO BE FILED WITH Exemption Application FORM YOUR for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 COUNTY ASSESSOR Read instructions on reverse side. Failure to properly complete or file this application In a timely manner shall result In a disapproval of the exemption. Name of Organization County County No. Type of Ownership Cp it-'ci v ` ` v {1 a a C-N t c t` f 6 f ai l d l 0 Nonprofit Corporation Street or Other Mailing Address v State Where Incorporated C ❑ Other(Specify) 13'114 T nest- CAL sr NE. / - D r City State rode Actual Value P. el or t' m w: (jYai A 31ArNd S2 \ T 000 ill L.. Legal description of real property and general description of all tangible personal property,except licensed motor vehicles: r`,\ 0 J ; 1 k C(\f _ : "\L h b S? rr 2 ('\ &t c:\ (L..0 c. g? I W C v y _Pro I) a v1-2 that t,)a y 1± [ IS \�) 1 t Vs C.C) /n pp (icsnc ' Title of Officers, Name Directors,or Partners Address,City,State,Zip Code • kit .t , ,f .1 twc - E • L. 'T• rood t6..Qa.t..a • .0 - 3Y(05 bQ(V:n'\V C Z as ) )tnt lift'S ,v4^d LSard , km. r a-0PC s■ kJ- "7 road 1 , 1 , . 'e -, ` 91 .;, i ErnIMIllt : IMME t lani C - N E :ts• Property described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural/Horticultural Society' ❑ Educational wi Religious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property: ?r r. v s d Q t c.d 5 is r`4:k4 -ro tk e 18 lit O C rA v,A L`cc G CA St NY *Agricultural/Horticultural Society does not need to complete the following questions. is all of the property used exclusively as described above? VYES �y❑NO t10 Is a portion of the property used for the sale of alcoholic beverages? ❑YES NO II Yes,slate the number of hours per week Is the property owned or used by an organization which discriminates in c-r membership or employment based on race,color,or national origin? ❑YES a�J 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 also declare that I am duly authorized to sign this exemption application. sign cJ a J'7 here nzed Sign a Title Date FOR COUNTY ASSESSOR'S RECOMMENDATION I ygc APPROVAL COMMENTS: F t 1 A -t 1— r'�Q r' ❑ APPROVAL OF A PORTION C �✓ - ❑ DISAPPROVAL ,Signature ty Asses rO�O Date - t� - FOR COUNTY BOAR F EQUALIZATION USE ONLY i declare that,to the hest of my knowledge and belief,the determination hereby made by the County Board of Equalization Is correct pursuant / to the laws of the State of Nebraska. Icy APPROVED COMMENTS: ❑ APPROVAL OF A PORTION /�] ❑ DISAPPROVED ��t/ e �SI9�. -'Cr r K� �� 'Ss. �� 4/ / Ignature of County Board r be all t Nebraska Department of Revenue or ..Rev.Stet.§P-202.01 96135-1999 Rev.7-201 o Supersedes 96135-1999 Rev.11-2008 FEB 1 7 2017 PLEASE MAKE A COPY FOR YOUR RECORDS HALL COUNTY ASSESSOR GRAND ISLAND, NEBRASKA