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File with Exemption Application FORM <br /> Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 <br /> Assessor Read instructions on reverse side. <br /> Failure to properly complete or timely file this application will result In a denial of the exemption. <br /> Name of Organizali n County Name Tax Year <br /> -T 0k'AID 121 F C viae/4- , N�tc L— C(C'G a <br /> Name of Owner of Property State Where Incorogcated <br /> AV t <br /> Street or Other Mailing,Address of plicant Total Actual Value of Real and Personal Property Parcel ID Number <br /> 1 81 ti W 5--z i*e kl e 08-03 $ e 01 Dca <br /> City State Zip Code Contact Name I �? Phone Number <br /> Type of Ownership M14 c .��/ILIG, )9 3i()._3Z �7 <br /> 0 Agricultural and Horticultural Society ❑Educational Organization n Religious Organization ❑Charitable Organization ❑Cemetery Organization <br /> Name Title of Officers, <br /> Directors,or Partners Address,City,State,Zip Code <br /> nfir- QL—�ClS1— ..gi a LEIZ)O ' 6.1 _3 <br /> 4 4 2,. Id, EL 2 - 0 L ' 44 $ 2 ' <br /> war /��(�j� <br /> A _ 2.L I C N/it1yJ3- � rut-- 4 ��[ti>rs�iev�z % / <br /> Legal description of real property and general description of all d reelable tangible personal property,except licensed mob vehicles: <br /> C l l Lzl.+'s A y)1 Ast of-{�i-c Et-z_ 01 o'i L'fS c7,gig Jo, 1 j /zr /3 au< °? <br /> Property described above is used in the following exempt category(please mark the applicable boxes): a` . <br /> 0 Agricultural and Horticultural Society 0 Educational y Religious 0 Charitable 0 Cemetery [` �i <br /> Give a detailed description of the use of the property: r l4 OC'C' i`�wp26�-v e l)5e4 as ck_ (11v1/c�;L C' r R ! 2 Co,/C <br /> I V <br /> / G 9��iss yes��>> <br /> All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. �FQ�sso9 <br /> Is all of the property used exclusively as described above? .�YES 0 NO 9s'14 <br /> Is the properly used for financial gain or profit to either the owner or owner or organization making exclusive use of the property? 0 YES Ettg0 <br /> Is a portion of the property used for the sale of alcoholic beverages? DYES 0 NO <br /> If Yes,state the number of hours per week _ <br /> Is the property owned or used by an organization which discriminates in membership or employment based on race,color, <br /> or national origin DYES NO <br /> Under penalties of law,I declare that I have e fined this exemption application and,to the best of my knowledge and belief,it is correct and <br /> complete- o d are that am du a this.exemption application. <br /> sign 4,e��/ " Aft) 7/////-7 <br /> here Authorized Ignature Title Dale <br /> Retain a copy for your records. <br /> For County Assessor's Recom JjiQf ldation J <br /> Approval COMMENTS: l lI <br /> Approval of a Portion 11// fff - 1 /[t ((}} (L.---) <br /> NI❑ Denial ' E` ry 1/so J are 1 <br /> I lure• n A sor <br /> For County Board of Equalization Use Only <br /> 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 <br /> � <br /> �• laws of the Stale of Nebraska. <br /> Approved COMMENTS: <br /> ❑ Approval of a Portion L/ ! <br /> ❑ Denied Ali i14.a�/ . i. ' / Id-3 —I. <br /> Si. of County B.: :, ember. Date <br /> County Clerk:A legible copy of this fo owing the final decision of the County Board of Equalization <br /> must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. <br /> Nebraska Department of Revenue,Properly Assessment Division Authorized by Neb.Rev.Slat.§§T]-202.01 and 77-202.04 <br /> 96-135-1999 Rev.1-2014 Supersedes 96-135.1999 Rev.7.2012 <br />