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APPEAL TO THE NEBRASKA TAX EQUALIZATION AND REVIEW COMMISSION READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING Fur ofltra use only.._,.._..._._.__._._- AND FILING AN APPEAL, o jr•, Please type or legibly print all information. 1. A separate appeal form must be completed and filed for each decision,action,order,or determi- 2,I • 11. nation from which you wish to make an appeal. A { 8 2011 J 2. A separate appeal form must be filed for each parcel of real property on which an appeal is based. 3. A separate appeal form must be filed for each taxable tangible personal property list on which an . I r i; ' - appeal is found. AND 1.-.5ftlie- 2 ._._-i 4. Each appeal must be accompanied by a copy of the decision, action, order or determination _ `' 1� appealed from or other documentation of that decision,action,order or determination. c/c4@ D&(O ( 0 I 5. A filing fee of$25.00 must be paid with each appeal,unless filed by a County Assessor,a County Q Board of Equalization,the Property Tax Administrator,or the'Pax Commissioner.A cheek or money RD order made payable to the Tax Equalization and Review Commission must he included with an appeal mailed to the Commission.Tho fee may be paid in cash if delivered personally.A refund of appeal fees may he made if multiple appeals are consolidated after filing,however,the filing fee must be paid Filing Fee: $ �5 for each appeal as filed even if a refund will be requested later. • 17 _ '`I O ADDITIONAL INSTRUCTIONS ARE ON THE REVERSE.IT IS IMPORTANT TO READ ALL Appeal#: / [' OF THE INSTRUCTIONS BEFORE FILING THE APPEAL FORM. Name,Mailing Address,CMaltAddress,Telephone and Fax Number of Person signing this form: Legal Description: OS'-' 3 7 4 ' 4440 For Red Property:Include Lot,Addition,Location, C. RAYG 112KSON Address,Section,Township,Range. )+Irst MI Last Daytime Telephone Number For Personal Propertyi Lid Description&Location: 0 wp.1g or- 3er5' - 1563 PRA1RZ6 CA4rEK Mile(if applicable) Pax Number '7 w'0 C Vs. NE llq I n-t2^L° Z ita EAST 1.4 toil' 3a Mtow Est EK9 KOS-x ,NC-T 't4. 9q Ac . . Street or other mailing address E"Mail Address GRAND xsf.ANO, N& is%))01 City State Zip Attach separate sheet If needed. Preferred method or contact other than regular mall E-M ItZ L, 1 am appealing from a decision of the 1-1 F Lt., County Board of Equalization 0 CHECK FILING STATUS pr I am signing as owner of the described property O I ant signing as a legally designated trustee of the trust O I um signing as an officer, director, full time employee etc.of ❑ I am signing as legal counsel for,0 I am signing as Ronson for Appeal:Be Specific.If additional space is needed attach additional sheers to each copy of This appeal torn. Under penal' 1 declare that the ArJe'�adon staled on this appeal form is,to the best of my knowledge and belief,true and correct. sign CRH 2 xt D %$o14 oviNra S^l-S- 1-1 here ,(Signature of Person Signing Appal) (Print your Name&Title if any) (Date) Filing Checklist: Appeal Form ❑ Decision ❑ Filing Fee !7 Signed❑ Mailing address:Tax Equalization and Review Commission,P.O.Box 95108 Lincoln,Nebraska 68509-5108 w111Ta Copy-TASK. kap the CANARY COPY Roo 09/2010 NIMadvlh 0,0a