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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 /> Failure to properly complete or file this application In a timely manner shall result In a disapproval of the exemption. <br /> N of Org nizatiop, <br /> � County zli" — <br /> Coun lo. Type of Ownership <br /> V gr y/z� A{7i El Nonprofit Corporation <br /> orpo <br /> ration <br /> Terry o f Add s p Stat W sr Incorpor ted ❑ Other(Specify) <br /> t o u� roSIta-) <br /> 9Krte (p e Actual Value Parcel or Location ID Number <br /> Ci 1 Vier <br /> L4nr,31 tot—k.0 <br /> LegA description of real property and general description of all tangible personal property,except licensed motor vehicles: <br /> Title of Officers, <br /> Name Directors,or Partners Address,City,State,Zip Code <br /> Property described above is used in the following exempt category(please mark the applicable boxes): <br /> ❑ Agricultural/Horticultural Society' ❑ Educational ❑ Religious ❑ Charitable ❑ Cemetery <br /> Give a detailed description of the use of the property: <br /> 'AgriculturaVHorticultural Society does not need to complete the following questions. <br /> Is all of the property used exclusively as described above? ❑YES ❑NO <br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES ❑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 ❑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 lam duly authorized to sign this exemption application. <br /> sign . ! %rtL , 1./i� <br /> here Authorized Signature Title Date <br /> 7yryT FOR COUNTY ASSESSOR'S RECOMMENDATION <br /> APPROVAL COMMENTS: P�./ n„yy�(� II- a. - 1 <br /> ❑ APPROVAL OF A PORTION `/"' 'I1W \J` <br /> ❑ DISAPPROVAL , as a 1 ___.Si- - h`__. I— Ct' \I <br /> Signature,'aunty .ssessor Date <br /> FOR COUNTY BOARD 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 /> 14 APPROVED COMMENTS: <br /> ❑ APPROVAL OF A PORTION <br /> aillP <br /> ❑ DISAPPROVED 1■Meniii i/i_:'./. L•t/aL _— - ±4,7-__ 7 <br /> e".nature o County Board '•er Date <br /> Nebraska Department of Revenue Authorized by Neb.Rev.Stat.§77-202.01 <br /> 96-135-1999 Rev.7-2010 Supersedes 96-135-1999 Rev.11-2008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />