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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 Grand Island Area Habitat for Humanity Hall 2018 Name of Owner of Property State Where Incorporated Grand Island Area Habitat for Humanity Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 502 W.2nd St. $26,000.00 400000423 City State Zip Code Contact Name Phone Number Grand Island NE 68801 Dana Jelinek 308-385-5510 Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization ®Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Brian Schultz President 812 W. 15th, Grand Island, NE 68801 John Nootz Treasurer 422 Rosewood Circle, Grand Island, NE 68803 Jennifer Bernth Secretary _ 104 Lakewood Circle, #15, Grand Island, NE 68803 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: Grand Island Original Town, Blk 7, Lot 3(117 W. 7th) • RE EIVED Property described above is used in the following exempt category(please mark the applicable boxes): DEC ❑ Agricultural and Horticultural Society O Educational ❑ Religious © Charitable ❑ Cemetery y /' 2 7 2017 Give a detailed description of the use of the property: t+ALL f ouNT The property was purchased for development. Engineered plans are being drawn now for bids, iBfittfrRyl urszsai¢1 underway in the first quarter of 2018. 22 lots,for low-income homes, will be developed. Home construction v6JJiMH g&IRA4„RA8. 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 properly used for the sale of alcoholic beverages? DYES ®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? DYES X.NO Under penalties of law,I declare that I have exami(vd this exemption application and.to the best of my knowledge and belief,it is correct and complete.I al • .eclare that I am..., .uthorized to sign this exemption application. sign th r�/ ,ilisi Executive Director 12/27/18 here Authorized Signature / Title Date Retain a copy for your records. For County Assessor's sso Recommendation Approval COMMENTS: • ! 'V "�f✓ + ❑ Approval of a Portion '`■ 1 I7 ❑ Denial .-ig to u y ffialt bate ()CI 1 -ig'atu Wu'sr•' -ssor ' 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 State of Nebraska. 4 Approved COMMENTS: _ -- —__- ❑ Approval of a Portion —. z -- i / `7 / ��/! ❑ Denied ��.� 4L.A 74 L —�9 -c Signa ur•of County=o. 1 Member Date County Clerk:A legible copy of thi. form owing the final decision of the County Board of Equalization must be delivered electronically to the Neb - - 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 96-1351999 Rev. -2012