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• iT 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 MARY LANNING MEMORIAL HOSPITAL ASSOCIATION HALL P078 Name of Owner of Property State Where Incorporated MARY LANNING HEALTHCARE NEBRASKA Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 715 N. ST JOSEPH $18,000.00 400521950 City State Zip Code Contact Name Phone Number HASTINGS NE 68901 Lisa Karr 402-461-5502 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization E Charitable Organization ❑Cemetery Organization Name Title of Officers, Directors,or Partners Address,City,State,Zip Code Jeff Anderson Chairman 5807 Osborne Drive. Hastings. NE 68901 Michele Bever Vice Chairman 606 N. Minnesota, Suite 2, Hastings, NE 68901 C.M. Anderson Secretary P.O. Box 756, Hastings, NE 68901 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: Personal Property-Sign Property described above is used in the following exempt category(please mark the applicable boxes): r�•� ❑ Agricultural and Horticultural Society ❑ Educational ❑ Religious ® Charitable ❑ Cemetery �E C F 1► /r•� r� Give a detailed description of the use of the property: ' I it \V/ tL_ rLlj JAN 0 2 2018 HALL COUNTY ASSESSOR GRAND ISLAND NEBRASKA 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 property? ❑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? ❑YES El NO Under penalties of law,1 declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complet o declare that I am duly authorized to sign this exemption application. sign k VULN -- - i here Auth ize ignature Ttle Date Retain a copy for your records. 1 For County Assessors Recommendation IQI Approval COMMENTS: .1 0 a ❑\Approval of a Portion • ❑ Denial turisk OIM[r air ) ) Signature if.my As =ssor oat- 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. 91 Approved COMMENTS: ❑ Approval of a Portion ❑ Denied W r a/ (23 -`7 re of County a•.to Member Date County Clerk:A legible copy of this • • showing the fina decision of the County Board of Equalization must be delivered electronically to the Neb .ska Department of Revenue within seven days after the Board's decision. i Nebraska Department of Revenue.Property Assessment Division Authorized by Neb.Rev.Stet.§ 77-202.01 ant 77-202.04 96-135-1999 Rev.1.2014 SuperseCes 96-135-1999 Rev.7-2012