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APPEAL TO THE NEBRASKA TAX EQUALIZATION AND REVIEW COMMISSION READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING Far officeoraontye ---------- AND FILING AN APPEAL. , Please type or legibly print all information. ,. 1, A separate appeal form must be completed and filed for each decision,action,order,or determi- - AUG ' I' nation from which you wish to make an appeal. , AUG I 8 2011 1 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 ?'T" - -,ii appeal is found. A nl vI "..:,....,,,../..,,:.--- A. Each appeal must be accompanied by a copy of the decision, action, order or determination appealed from or other documentation of that decision,action,order or determination. c_/<.4 0X L0 ( 1/ 5. A filing fee of$25.00 must be paid with each appeal,unless filed by a County Assessor,a County MO Board of Equalization,the Property Tax Administrator,or the Tax Commissioner.A check or money order made payable to the Tax Equalization and Review Commission must he included with an appeal mailed to the Commission.The fee may be paid in cash if delivered personally.A refund of appeal e- $ � fees may he made if multiple appeals are consolidated after filing,however,the filing fee must be paid Piling Fee, $ d' for each appeal as filed even if a refund will be requested later. 1 y O ADDITIONAL INSTRUCTIONS ARE ON THE REVERSE,IT IS IMPORTANT TO READ ALL Appeal#: �1 OF THE INSTRUCTIONS BEFORE PILING THE APPEAL FORM. Name,Mailing Address,g-Matl Address,Telephone and Fax Number of Person signing this form: Legal Description: C. gm 2 G D 2 Se N 3 08- 3'1 4 - 44 of U For/teal Property:Include Lot,Addllion,Location, Address,Secden,Tewnehip,Range, }ust Mt Last )ayurne Telephone Number For PersonalProperty:List Description Se Location: bwNEfZ 30S 3ctS - 1510.3 PRA..taz Ci.h'k'K Tide(if applicable) Fax Number 'T W'P C '/e. NF Ys I tr-t2.-to 2lI0EA5 7' FIw'( 30 MxowEs-rEK @KOSx . MC-T 99. 9SAC Street or other mailing address E-Mall Address GAANty XSI.ANO, WE &toper% City State Zip Attach separate sheet tf needed, Preferred method of contact other than regular mail E-.Iv)'Pr- 1 ant appealing from a decision of the g W A Lt- County Board of Equalization ❑ — CHECK FILING STATUS jir I am signing as owner of the described property ❑ I am signing as a legally designated trustee of the trust ❑ I am signing as an officer,director, full time employee etc. of C I am signing as legal counsel for ❑ I am signing as. Reason For Appeal:Be Specific.If addlilaml space is nestled attach additional sheers to each copy of Ns appeal form. Under penal' w I declare Met the adult stated on this nppeat fora:ir,ro the best of my knowledge and belief,true and correct. sign yh eQA?. Ca D'1%3oN owNE4 8.`i-5-- 1-) Print your Name&Title if any) I (Date) here (Signature of Person Signing Appeal) ( Y Y) ( Filing Checklisrr Appeal Ferns ❑ Decision 0 Filing Fee ❑ Signed❑ Mailing address:Tax Equalization and Review Commission,P.O.Box 95103 Lincoln,Nebraska 68509-5108 'Vi 11111 Copy-TA.II.C. Kass ac CANARY COPY Ito.09,2010 Plleea wen tat as