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Fie with Exemption Application FORM <br /> Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 <br /> Assessor need Instructions on reverse skis. <br /> I Failure to property complete or timely file this application will result Ins denial of the exemption. <br /> Name of Ormanlzatlal County Name TaxYear <br /> Nebraska Medicine Internal Medical Associates Hal 1 2018 <br /> Name a1(Moroi Property See Wham incorporated <br /> Nebraska <br /> Skeet or Other Mai$rgAddress of Applicant TidatActual Saks of Real end Personal Property Parcel ID Number <br /> 729 N Custer $543,374.00 400521930 <br /> City Stale rap Code Contact tame Phone Number <br /> Grand Island NE 68803 James MclAulen 402-559-2194 <br /> 'Gyps of Ownership ' <br /> QAgrkukuw end Horticultural Soapy 0 EMicadonalOrganimfion 0 nalessOrganization fCharlmble Organisation °cemetery Organization <br /> Name Tttie of Officer*, <br /> tilt Directors,or Partners Address,City,State,Zip Code <br /> See Attached <br /> LendesuYpaen at rear property-and went description of all depmclade tangible personal'property:except Icenssedmowrwhidee•. <br /> klecficid and office equipment for use of the clinic-is6ggattached <br /> RECEIVED <br /> DEC 9 R <br /> Property dessert above a treed in the following swept category Urleese made theapplicable bona)_ <br /> °Agricuarrataadllortiegbrnk.3ociety 0 Educational 0 Religious IX Charitable � � HALL COUNTY r-ruS <br /> e ANo tcLAN0. ESSOR <br /> Gies a detailed dexdptioname tae a me pmpenr NE6 4SKq <br /> Specially care medical diric with Trials <br /> pedae Infernal Medicine, , Infusion Center,PWmonaryFundionTests, <br /> and d <br /> 1 Full Lab At organizations,incept for en Agricultural and.Horticultural Society,must complete the Clewing questions. <br /> tsdforsta property used a*rske,as describedMeve? a;YES ONO <br /> Is the property used far Ilnerrdargain or pant le either the owner or owner or organization malting exclusive use of the property? OYES 1:.NO <br /> Is a nodose*the property used tor Ike sale of atohotc beverages? AYES ig NO <br /> If Yes,Meths number of hoes per week <br /> is the properly.,owned Of used by organization which dscrtnkmes Inmembeehlpor employment based on moo.copy. <br /> or national origin? °YES 'NO '.. <br /> Under penmtles of Sr.I declare that I emranedtes semen en application and,tithe beet or my knowledge and beget,it is correct and <br /> tWO tpageads exemption application <br /> sign , .-^' Cln;&9&pey, Litt;. ialad/� I <br /> cuing Signature Titre / Date <br /> 6 Retain a copy for your records. <br /> fir. For County Assessor's Recommendation k I) <br /> [�( Approver COMMENTS: 1 7 fl- I a <br /> 0 Appmvallata Portion i <br /> Dental ;�ri►tativi�1I/ G�NINIIII <br /> I For County Board of Equalization Use Only <br /> I declare that to the test et my knowledge and belief,the determination made byte County Board of Equalization rr coned pursuant to the i <br /> laws of the State of Nebraska. <br /> Approved COMMENTS: �\ <br /> Approver of a Portion <br /> Denied . -__ - 8 _ <br /> of Couny Bnerd. .,... Date I <br /> County Clerk:A legible copy of this . • tag the final decision of the County Board of Equalization <br /> must be delivered electronically to the Neb - r -partment of Revenue within seven days after the Board's decision. <br /> Neberka Depaament of Revenue.63099r1yAan•9msm Division Authorized by Nab.Rev.Slat.4f,71-202.01 and 77202.oa <br /> 96.136.1999 Rev.1•2074 Supersedes 98136-1999 Raw 7.2012 <br /> i <br /> 1 <br />