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File with Exemption Application FORM Your County for Tax Exemption on Real and Personal Property by Qualifying Organizations 4.51 Assessor Read instructions on reverse side. Failure to properly complete or timety file this application will result in a denial of the exemption. Name of Organization County Name Tax Year Central Nebraska Community Action Partnership(fmrly Centre Hall County 2010 Name of Owner of Properly State Where Incorporated Central Nebraska Community Action Partnership Nebraska Street or Other Mailing Address of Applicant Total Actual Value of Real and Personal Property Parcel ID Number 626 N Street, P.O. Box 509 $93,709.00 400375729 City State Tip Code Contact Name Phone Number Loup City NE 68853 Judy Hughes 308-745-0780 Type of Ownership El Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization ®Charitable Organization ❑Cemetery Organization Name Title of Officers, Address,City,State,Zip Code Directors,or Partners Cheryl Holcomb CNCAP Ex.Director P.O. Box 509, Loup City, NE 68853 Judy Hughes Housing Director P.O. Box 509. Loup City, NE 68853 Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: Cairo South Loup Village Second Addition Lots 5 and 6 Block 4 RECEIVED EC 2 s 2017 $ � • 3o1 E#yp* ' HA Pro a described above is used in the fill exempt category(please mark the applicable boxes): n . p are aPP GR F1OD:SLAND, N_FgRgSKA ❑Agricultural and Horticultural Society ❑ Educational ❑ Religious N Charitable ❑ Cemetery Give a detailed description of the use of the property: This property is used for rental housing.We are a nonprofit organization and provide housing opportunities to low-income individuals and families. y CNCAP was formerly Central Nebraska Community Services. IVO l Q - .--pr° bus r»CSS All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exclusively as described above? N YES ❑NO Is the property used for financial gain or profit to either the owner or owner or organization malting exclusive use of the property? ❑YES N NO is a portion of the property used for the sale of alcoholic beverages? ❑YES N NO If Yes,state the number of hours per week Is the property owned or used by an organization which dis =minates in membership or employment based on race,color, or national origin? ❑YES �S NO . Under penalties of law,I declare that I . =examined this exemption application and,to the best of my knowledge and belief,it is correct and complete. .i s.declare that •2d to sign this-.•-mption application. / ,A ' Sign �j_r, .,a,ii_,.?lL_i Executive Director 12/14/2017 here " • zed Signs = — Title Date Retain a copy for your records. For County Assessor's Recommendation ❑ Approval COMMENTS: N . ,, ' -(` N) + a \ a �C{ 1 Ir� I U UN 0', '}. :J 1 6101. I tut✓ e. y�'pkir 1(a/0�iNH 1. Approval of a Portion L l U` �1L � �1""� l ❑ APP '(ll'/^'i1 I Denial �1 , `^'{�(✓''j�i/n�/I}J� Ialaco �- ct5 � Signature unY tyViessot &te 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. ❑ Approved COMMENTS: ❑ Approval of a Portion 41,. a A .rte_es-e /- 3 t �� Denied of County ar tuber Date County Clerk:A legible copy of this' - f• • howing the final 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 De arhnent of Revenue,Property Assessment Division Authorized by Neb.Rev.Stat.§§77-202.01 and TS202.o4 96-1351999 Rev.1-2014 Supersedes 86135-1999 Rev.7-2012