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'r=ile with Exemption Application FORM • Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 Assessor Read instructions on reverse side. I Failure to properly complete or timely file this application will result in a denial of the exemption. Name of Organiz ion I //�� 1 County Nam TaxYear Sf. /on's ( haicc l�hucC�� Nalt 2018 Name of Owner of Property State Where Incorpora S1-7 f-nn s (',a {ho hr (-Au rc.( ∎ N(Jo r-a s Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number PO (3o c 907 State Zip Code $on32N)/959 Phone 001 3730 Ciity / �] -ntactt -/y�7 {- .(� Number 2 /J TDoni rshkan �F to KO ` �r) e /Demur k ID� !1 N - -2,7 7 ❑Agricultural and Horticultural Society • ❑Educational Organization Religious Organization ❑Charitable Organization ❑Cemetery Organization - TiUe of Officers, Address,City,State,Zip Code Name Directors,or Partners QMtS I. f1 NPar�tr "♦ it ., '�i.A MI I n .b A '!4.550 - atL �[l � a/-L. al) S rri r, Jf. 'N (0 I-) L .. 0 - irffillarifflaINITMEZ5111M Pb 4. .l •.rift an • 2 Legal description of real p••-rty and general description of all depreciable tangible personal property,except licens:•motor vehicles: d Lt 3 BI 3 TO r, IOha� �/i 11age Gl deo n's a � Properly described above is used in the following exempt category(please mark the applicable boxes): , ❑Agricultural and Horticultural Society ❑ Educational 'Yd Religious ❑ Charitable ❑ Cemetery Give a detailed description of the use of the property: n a 7"� us�r RECEIVED �hrader Gar a�n- -C-or- l- DEC 182017 All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. H' CO ITV ASSESSOR Is all of the property used exclusively as described above? (j°:l i IS MAY NEBRASKA Is the property used for financial gain or profit to either the owner or owner or organization making exclusive use of the property? .. mi S '2i •' Is a portion of the property used for the sale of alcoholic beverages? ❑YES ONO 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 TA Under penalties of law,I declare that I have e -d this exemption application and,to the best of my knowledge and belief,t is correct and complete lare that 1 autho r• this exemption application. sign �c1>_ hasr la l3 /7 here • Authorized Signature " Title Date Retain a copy for your records. I For Couun�tyt Assessor's Recommendation I 11, Approval COMMENTS: 1 1 '?ea, ❑ Approval of a Portion X Denial I A I : Signatur-CIP ounty Assessor Date I For County Board of Equalization Use Only I 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 R laws of the State of Nebraska. Approved COMMENTS: ❑ Approval of a Portion a Denied n /--; -28' re of aunty x•-rd Member Date County Clerk:A legible copy of thhowing the final decision of the County Board of Equalization must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. Nebraska Department of Revenue,Property Assessment Dnon Authorized by Neb.Rev.Slat.§§77-202.01 and 77402.04 06-135.1999 Rev.1-2014 Supersedes 96-135-1999 Rev.72012