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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 • , -. .t 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 ocgaruzati - 4 , - - Co ty Name Tax Year r 'J
<br /> r�- a A�t� «i (r,oIcn 1 t�A A FALL Cm.NI j 4
<br /> Name of Owner of Property ` Slate Where Incorporated
<br /> �ls-i-airI Aay.,3xy __% State
<br /> Neetasizz i iigcc NE AsCA
<br /> Street or Other Mailing Address of Applicant - - Total q lue•of�Aepj arsonal Property
<br /> 2BIS D'SNe-A ��)4Q, $ �, IJ�J
<br /> city State Zip Code can acl Name Pone Number
<br /> Limcbist NC bESi(o 1)41.1 �oe, 4b2. g7 1.DD74
<br /> Type of Ownership
<br /> ❑Agricultural and Horticultural Society ❑Educational Organization Religious Organization ❑Charitable Organization ❑Cemetery Organization
<br /> Name co of Officers,
<br /> Directors,or Partners Address,City,State,Zip Code
<br /> • Dict
<br /> _ 1 0 lo. 1,_a4- . 3 4 Ill e, 'a„_ NC 68St/v
<br /> a 4 _ k e.-.•riINIIIIIIIK-- e- lot ErinniMail • I NC a :rD
<br /> tit s . Qu ,SD • ' £, _:r As L ,etiv
<br /> Legal description of real property and general description of all depreciable tangible personal prope y, , '-pt licensed motor veh•-s:
<br /> 1 !2y 1• &
<br />,
<br /> @QM�d srml,� , Al bggv 3
<br /> Property described above is used in the following exempt category(please ark the applicable boxes):
<br /> ❑ Agricultural and Horticultural Society ❑ Educational Religious ❑Charitable ❑ Cemetery _.
<br /> Give a detailed description of the use of the property: TTT"'CCC
<br /> JJe8 c C1vC >,n J\ 04,1 ctig rsh 1'p .r v l S r€ I _ n\w
<br /> FEB 122. 3
<br /> All organizations,except for an Agricultural and Horticultural Society,must complete the following questions.
<br /> Is all of the property used exclusively as described above? *EC� AS SE ti"O
<br /> Q'9!i N4'ri,,.,E�avR
<br /> Is the property used for financial gain or profit to either the owner or owner or organization making exclusive use of the property? W.ND F` 19 `1, '
<br /> rr
<br /> it WtS t\Jf';A
<br /> Is a portion of the property used for the sale of alcoholic beverages? ❑YES C NO
<br /> If Yes,state the number of hours per week_
<br /> Is the property owned or used by an nization which discriminates in membership or employment based on race,color,
<br /> or nationalon•n? ❑YES ��y1(NO
<br /> ■ •- penalties of w I declare that I have examined this exemption application and,to the best of my knowledge and belief,tl istlowect and
<br /> co p e.I also decla th t I duly authorized to sign this exemption application.
<br /> sign �� I 4s: X0,4 a. s 16
<br /> here Authonz:•Signature — Title Date
<br /> Retain a copy for your records.
<br /> For County Assessor's is Recommendation _
<br /> yiApproval COMMENTS: 7 fl 62
<br /> ❑`Approval of a Portion _
<br /> ❑ Denial 19911�4`1111, I//1 , r- ,M1A
<br /> gna re,�Y_y Asses=or rate
<br /> For County Board of Equalization Use Only
<br /> 1 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 /> ,,,���---,,,fff laws of the State of Nebraska.
<br /> pD Approved COMMENTS: C.
<br /> ❑ Approval of a Portion /
<br /> ❑ Denied Al Litil dre_d4 _wit iii ——
<br /> Signal •of County'•: • ,ember - Date
<br /> County Clerk:A legible copy of thi- for -howing the final decision of the County Board of Equalization
<br /> must be delivered electronically to the Ne. . - a Department of Revenue within seven days after the Board's decision.
<br /> Nebraska Department of Revenue.Property Assessment Division Authorized by Neb.Rev.Slat.§§77-202.01 and)J-202,04
<br /> 96-1 3.5.1999 Rev.1-2014 Supersedes 96-135-1999 Rev.7-2012
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