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File with I Exemption Application FORM Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations Assessor Read buuucflorw on mane side. 451 Failure to properly complete or timely the this application will result Ina denial of the exemption. Name of Organization County Name Tax Year Lutheran Family Services of Nebraska, Inc Hall 2018 Name d Owner of Property State Where Incorporated Lutheran Family Services of Nebraska,Inc Nebraska Street or Other Mailing Address of Applicant Tote)Meal Value of Real and Personal Property Parcel ID Number 1811 W.2nd Street, Suite 440 $100.00 WA City State Zip Code Confect Name Phone Number Grand island NE 68803 Steve Peterson 402-978-5645 I of ownership ❑Agriu,m,ral and Horticultural Society ❑Educational Organization N Religious Organization ®cheritable Organization ['Cemetery Organization Name The of Oiticars. Address,City,State,Zip Code Directors,or Partners Susan Lewis Board Chair 124 S.24th Street Omaha, Nebraska 68102 Debbie Fraser Vice Chair 124 S.24th Street Omaha.Nebraska 68102 Kim Sucha Treasurer 124 S.24th Street Omaha. Nebraska 68102 Legal desorption of real properly and general description of all depreciable tangible personal property,except licensed motor vehicles: General mist office equipment Property described above b used N the following exempt category(please mark the applicable bones): R E I b E ❑Agricultural and Horticultural Society ❑ Educational K. Religious E+ Chadtee" ❑ Cam DEC a 'j 2t}17 Give a detailed description of the use d the property: NAZI_ cOUNrY R Misc office equipment used in the delivery of our services GRAND ISLAND ASSESSO NEBRASKA At organizations,wept for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exduaNey as descnbed above? ts, YES ONO is the property used for financial geld or profit to abler the owner or owner or organization making erduaive use of the property? ❑YES ENO Is a portion of the property used for the sale of alcoholic beverages? ❑YES N NO t If Yee,state the number of hours per week Is the property owned or used by an orgaraatlon whldr discriminates In membership or employment based on race,color. or nedo rW ? ❑YES 1?No 1 Minds•penalties of law,I dad that I have examined this exemption application and,to are best of my knowedge and beget,It is correct and I 1 declare tit I d authorized a sign this eimnpfon application. Sign , , 1 Director of Property a Risk Man 12-27-2017 I here Authorized Signature Title lets Retain a copy for your records. I For County Assessor's Reccoo�m�my�endation t Approval COMMENTS: 't/ l/Approval of a PortionF ❑ Denial .IVIr_,,� En ifir SL. ., .�• ray lie I 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 Sete of Nebraska. i 1 Approved COMMENTS: t ❑ Approval of a Portion a ' / ❑ Darden _ d County_n •Me .. County Clerk:A legible copy of this • owing the final decision of the County Board of Equalization 1 must be delivered electronically to the Neb - Department of Revenue within seven days after the Board's decision. Nebraska peearknmt of gexenue,Pmpe.ty Amassment Warn Authoring by Nab.RRN.em.si 7720101 and 77202.04 a ee1s41990 Rea.1-2014 Supersedes 841341999 Res.72012