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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 ST. STEPHEN'S EPISCOPAL CHURCH HALL 2017 Name of Owner of Properly State Where Incorporated WARDENS AND VESTRY OF ST. STEPHEN'S EPISCOPAL Cl NEBRASKA Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 410 W.2ND STREET- R. O. BOX 2317 $26,856.00 400005212 City State Zip Code Contact Name Phone Number GRAND ISLAND NE 68802 DR. REV. ROBERT LEWIS 308-382-4961 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 REV. DH. HOI3EH I M. LEWIS 'HEO I UH 2642 CARLE ION AVE.#8 GRAND ISLAND, NE 68803 MRS. JERRE MALLORY SENIOR WARDEN 802 SUN VALLEY DRIVE GRAND ISLAND, NE 68801 MR. DONALD YOUNG PEOPLE'S WARDE 402 RENEE ROAD DONIPHAN, NE 68832 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: ST. STEPHEN'S SUB L14400005212(CHURCH PARKING LOT) Property described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural and Horticultural Society ❑ Educational ® Religious ❑Charitable ❑ Cemetery Give a detailed description of the use of the ro en FOR PARKING FOR THOSE TP-IAT COME TO WORSHIP OUR LORD AND SAVIOR AT THE CHURCH BUILDING SUPPORTED BY DONATIONS 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 (i 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 t,�dr NO Is a portion of the property used for the sale of alcoholic beverages? ..0 YES ®NO i 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? a YES ®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 a cla that lam duly authorized to-'gn this exemption application. sign J/ 1 _ RECTOR 12-21-2016 here • Authorized Signature Title Date Retain a copy for your records. For County Assessor's Recommendation ; I Approval COMMENTS: (C� r' 71— c�Ce J ❑ Approval of a Portion ri T \ . 1 ti`{ El Denial Signature o ity-lessor �= Date For County Board o-Equalization Use Only I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization s correct pursuant to the laws of the State of Nebraska. aApproved COMMENTS: ❑ Approval of a Portion nn —�^'� ID Denied fir - � G71 gnalure St County Board 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 thprd's decision. Nebraska Department of Revenue,Properly Assessment Division Authorized by Naffay.96t4$77-20201 and 77-202.04 96-135-1999 Rev.1-2014 supersedes 96-1351999 Rey.7-2012 _ ` 20/6