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File with Exemption Application FORM Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations �5 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 Community Action Partnership(fmrly Centre Hall County 2018 Name of Owner of Property State Where Incorporated Central Nebraska Community Action Partnership Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 626 N Street, P.O. Box 509 $90,056.00 400168723 City State Zip Code Contact Name Phone Number Loup City NE 68853 Judy Hughes 308-745-0780 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization N Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Cheryl Holcomb CNCAP Ex.Director P.O. Box 509. Loup City, NE 68853 Judy Hughes Housing Director P.O.Box 509, Loup City, NE 68853 Legal description of real property and general description of al depreciable tangible personal property,except licensed motor vehicles: Cairo South Loup Village Second Addition Lots 1 and 2 Block 4 XC City RECEIVED DEC 262017 resj /03 Said HAI i nnliNTY ASSESSOR Property described above is used in the following exempt category(please mark the applicable boxes): GRAND ISLAND, NEBRASKA ❑Agricultural and Horticultural Society ❑ Educational ❑ Religious N Charitable ❑ Cemetery Give a detailed description of the use of the property: This property is used for rental housing. We are a nonprofit organization and provide housing opportunities to tow-income individuals and families. t n • _ nL L taw in t& CNCAP was formerly Central Nebraska Community Services. iS is n't a -1-or pro 7'r•� 6 All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exclusively as desalted above? N YES ❑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 N NO Is a portion of the property used for the sale of alcoholic beve.•es? ❑YES N NO It Yes,state the number of hours per week Is the property owned or used by an organization which di-•iminates in membership or employment based on race,color, or national origin? OYES El NO Under•- afiles of law,I .-•.re r I -. - examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. s -• e th. am duly. u.- -'to sign this,r- ption application. Sign ,ar1i.Q., t Executive Director 12/14/2017 here Auih• zed Signal Title Date i Retain a copy for your records. For County //Assessor's�Recommendation ft V�' Mfg i 1�-!� ❑ Approval COMMENTS:Lxtu`Vyg.I(U.t' Ut�clt Vu __ I�1rt1ll(�1_,...,�. . S.,Iii I �,V••�,,.BIt,�,t�i(Al Buffalo Co�n!,rcit..I /��r�,I, El Approval of a Portion a�13 NOb: I J i'i"L!)—Supt�.(ouX-I f Ul.wt low'tSA'tl Iti is''lr"^ Chkr ilium, VI Denial .. 4 i l (� , / \ Signal rr Coun Asse'sor Date For County Board of 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. ❑ Approved COMMENTS: ❑ Approval of a Portion - , / / �t `4/I Denied = -- a w /O241g d`- ignatun f ,unty Board Mem:'r / 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 the Board's decision. Nebraska Department of Revenue,Property Assessment Division Authorized by Neb.Rev.Stet.§§77-202.01 and 77-20204 96-135-1999 Rev.1-2014 Supersedes 96135-1993 Rsv.7-2012