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TO BE FILED WITH Exemption Application FORM <br /> YOUR for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 <br /> COUNTY ASSESSOR Read instructions on reverse side. <br /> 1-1, Failure to properly complete or file this application in a timely manner shall result in a disapproval of the exemption. <br /> ��nn pp(� r8ayy etior,/'+ County}, �I n County No. Typie p1 Ownership <br /> I1rif� i yI�/'1i.9 fit ra i (inc . <br /> "' I/ ',y // YbL..NCnprofit Corporation <br /> (J\/�( ( AJ(�t) (J/� (' 1 Ll 5 e rttteiiillttnc[.LLo.XCC rJJJ1e '❑f Other{Specify) <br /> St�get�r Qtbpr ai'ngAgdress �( n � <br /> Cifi/l\. C.i ct 1(.� fate / V E ��/ 1 Actual Value P l : (`J/ <br /> Legal script 7 of rrr/���,aa ppr-oJC/eU/]tla genemtsioniption of act 1,ng perspna�eolpe' xcept lieersymot ' 1 <br /> //IIIVVVIIJJlJJ1111YY 1111 r�' /V IL-v` 1 i0]� (//•(F l/•IY VII l/✓IT' !_JI, I <br /> `f Title of Officers, <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> lifffilliffirMAII re 5 i i n-1- IRELMialiallat.t'av C' U,i>a' 4 te a C t <br /> ""IiiiiifflniaM % (eCkSL, I ke. 1 w. V i rftvld 0kc ld ' L.A. 0 <br /> AMEMIIIM=Inlinf ttellr \ran_ 151 nd L" • (e . &p <br /> Y • SC - % 0- { nargirlEirlipa6,r'afid. isicon L hit lz; ,o <br /> •roperty described above is used in the following exempt category(please a7 the applicable boxes): <br /> ❑ AgriculturatiHorticultural Society' ❑ Educational {SReligious ❑ Charitable ❑ Cemetery <br /> detailed description of the use of the property: <br /> fine. fro/ems 5 Inc-wlG 'u -cc wwrc,V\ serv (LES <br /> * ulturaVHorticulural Society does not need to complete the following questions. <br /> g of the property used exclusively as described above? M YES NO <br /> tion of the property used for the sale of alcoholic beverages? YES NO If Yes,state the number of hours per week <br /> operty owned or used by an organization which discriminates in <br /> hip or employment based on race,color,or national origin? ❑YES a NO <br /> 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 <br /> complete.I also declare t duly authorized to sign this exemption application. <br /> 1 . <br /> �' 9017- <br /> sig �1--r . <br /> here b0 :. <br /> FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> i APPROVAL COMMENTS: P...r y� \ 1 {r-an_ <br /> ❑ APPROVAL OF A PORTION !` <br /> ❑ DISAPPROVAL '------- <br /> 1 J� /i- - .r Q- - <br /> L <br /> Z" Vf <br /> Signature o •�my Assessor Da te <br /> FOR COUNTY BOARD • <br /> EQUALIZATION USE ONLY <br /> I declare that,to the best of my knowledge and belief,the determination hereby made by the County Board of Equalization is correct pursuant <br /> to the laws of the State of Nebraska. <br /> Itsi•APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION - <br /> 4. <br /> .111 DISAPPROVED ism- ii 2ararLLs ! -- 3r _ 1 L <br /> p��—j <br /> ignatu =of ounty Board M:,',C�,r - Date f <br /> ,ebraeka Department of Revenue Authorized by Nab.Rev.Stat. 77-202.0} <br /> 96.135-1999 Rev.7.2010 Supersedes 96-135-1999 Rev 11-2008 ..-__ 3D - ii <br /> PLEASE MAKE A COPY FOR YOUR RECORDS t.L'.. <br />