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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 Central Nebraska Humane Society Inc Hall 2017 Name of Owner of Property State Where Incorporated Central Nebraska Humane Society Inc Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Properly Parcel ID Number 1312 N Sky Park Rd $75,000.00 400015080/400015099 City Stale Zip Code Contact Name Phone Number Grand Island NE 68801 Laurie Dethloff 308-385-5305 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization El Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Laurie Dethloff Executive Director #21 Kuester Lake, Grand Island, NE, 68801 Tanya Hansen Board President 2007 W Lamar Ave, Grand Island, NE, 68803 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: FRANK P BARKS SUB NO 3 LTS 35-36-37 & PT VAC JERRY ST FRANK P BARK SUB NO 3 LTS 38&39 & PT VAC JERRY ST R E C E' ED JUN 2 3 1 7n1 Property described above is used in the following exempt category(please mark the applicable boxes): HALL❑Agricultural and Horticultural Society ❑ Educational ❑ Religious ®Charitable ❑ Cemetery G A/.,,, .r �I QTY FISS S'So !31 :.f-LI, 1IC k Give a detailed description of the use of the property: �5 KQ Currently using it for enrichment and walking dogs. We intend to continue to make improvement to the area for volunteer and shelter use for animal enrichment. Two small buildings for storage. 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 ❑NO Is the property used for financial gain or profit to either the owner or owner or organization making exclusive use of the properly? ❑YES ®NO Is a portion of the property used for the sale of alcoholic beverages? ❑YES ®NO 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? 0 YES [8]NO Under•enalties of law,I(leclar-that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and comp-let!so declare that I am du -uth• ized to sign this exemption application. sig itA A-_ iA 2At_ � ' 026-/7 her- '� .rized Signature / Title copy for your records. I For County Assessor's Recommendation coommendation 1 54 Approval COMMENTS: PILO IV 9.\ 1 —AC)a ❑ Approval of a Portion 1 Co' ]pI ❑ Denial en.. . � . % % . � % t 'G1 t—�'T Signature of Ti un Assessor Data I For County Board •f Equalization Use Only I declare that to the best of my knowledge and belief,the determination made by the County Board of Equalization is correct pursuant to the laws of the State of Nebraska. 0 Approved COMMENTS: ❑ Approval of a Portion ❑ Denied /A,Fi.. y., e // aol 7 ignature of County �•ard I.-mber oo®®®a�aTfTe�e / 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 the Board's decision. Nebraska Department of Revenue,Property Assessment Division Authorized by Neb.Rev.Slat.§§77-202.01 and 77-202.04 96.135.1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012