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TO BE FILED WITH Exemption Application FORM
<br /> YOUR forTax Exemption on Real and Personal Property by Qualifying Organizations 451
<br /> COUNTY ASSESSOR Read instructions on reverse side.
<br /> Failure to properly complete or file this application in a timely manner shall result in a disapproval of the exemption.
<br /> Name of Organization County County No. Type of Ownership
<br /> e—1 by(� /1 y t / sunj God_ , t I ' Nonprofit Corporation
<br /> Street or Other Mailing Address h-f f.( P`� State Where Incorporated ❑ Other(Specify)
<br /> 3 O(, w d LA,/ 30
<br /> State / Zip Code A I I Parcel or Location ID Number
<br /> City f�t'P.rY tD1 L nI'Niyw)
<br /> �� =51cLr.ra i.f (.n S�io3 l.tl'I<Jil!! [�� cJXVI.✓
<br /> Legal description of real property and gene al description of all tangible personal property,except licensed motor vehicles:
<br /> L-o4-one L 1 ) , 6, O L a F.owrt-h O.AhcLiu's.'on , rn S+.- C./a-y 4,4 S tu-'d zstan.df i_kt.i Cow,.L9,
<br /> AlthraAL L,
<br /> Title of Officers,
<br /> Name Directors,or Partners Address,City,State,Zip Code
<br /> l�' tor.x.“ld-Inn IL-IM- Pa S,1or is(o s'1 u - In 4 !cm n w.koo-4...,e.)rc 4 is/arta. Ax' a wL%0$
<br /> \shame,F4em en tn(rSts0 b°' ITn"''cux'� 4to e b.:U5,oa St, Coru.nd S5 tan d 6So2 io!
<br /> fD1,ork_ ticrnrn.nyd SCfl D.rtc.bor cno e l,r,y.S%an SI-. &sand--ts/wfl. AC Lebfkfi
<br /> W LHn Q-1u " ,I .r«kor 9LIOf-I W. A:. f=ront SY. C.ra-n4.1`slccao. A'€ 09 of
<br /> RI ic,,ard mts1.9 lc ,D:reach.- 30344 1U. Icj''!'Si-. orand3sfcuvl }.. (ooiu3.
<br /> Property described above is usee in the following exempt category(please mark the applicable boxes): c-ka s Jo:eb p f-cA-c(3 M- 11-440-t Ma.
<br /> ❑ AgriculturaVHorticultural Society* ❑ Educational jg Religious ❑ Charitable ❑ Cemetery
<br /> ,ft"-
<br /> Give a detailed description of the use of the property:
<br /> Pl �SCm 61`1 r5 God e-h a-ceh wt ,,�.e�l..,l,-l.a t )..FJ-t LI,4-f{,a -- `
<br /> (J NOL r P2016 .
<br /> *Agricultural/Horticultural Society does not need to complete the following questions.
<br /> Is all of the property used exclusively as described above? Ni YES ❑NO
<br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES II NO If Yes,state the number of hours per week
<br /> Is the property owned or used by an organization which discriminates in
<br /> membership or employment based on race,color,or national origin? ❑YES I 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 that I am duty authorized to sign this exemption application.
<br /> sign � L. / Q I!-f'-/(
<br /> here onzedSignature No Date
<br /> FOR COUNTY ASSESSOR'S RECOMMENDATION
<br /> APPROVAL COMMENTS: cf
<br /> -2( 77 An
<br /> ❑ APPROVAL OF A PORTION //�� � � � �
<br /> ❑ DISAPPROVAL ' fl r� oil: 0 a�.1 ems_,,, i.:�' L— t7-- ‘�
<br /> Signature r ounty ssessor Dale
<br /> FOR COUNTY BOAR A•F 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 /> *APPROVED COMMENTS:
<br /> ❑ APPROVAL OF A PORTION
<br /> ± / � .0,❑ DISAPPROVED // / r `t a/
<br /> A) 7
<br /> ignature of ounty Board a y:r Date
<br /> Nebraska Department of Revenue Authorized by Neb.Rey.Slat.677-202.01
<br /> 96-135-1999 Rey.7-2010 Supersedes 96-135-1999 Rey.11-200B
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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