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e \........\0 File with Your County Exemption Application FORM Assessor on or for Tax Exemption on Real and Personal Property by Qualifying Organizations 451 Before December 31 Read instructions on reverse side. Failure to properly complete or timely file this application will result in a denial of the exemption. Name and Address of Organization County Name Tax Year HALL 2026 State Where Incorporated CENTRAL NEBRASKA LUTHERAN NEBRASKA SCHOOL Value of Real Property Value of Personal Prop Parcel ID Number 3900 W HUSKER HWY $ 24.4 (co $ 75,060 400201100 GRAND ISLAND, NE 68803 Contactyyte Phone Number LII..I§ihiumiiiiniii.i.iii d 30E-3 -o7,53 x4 Name of Business,_if Different than Organization G Email Address y & ;Arils L. , 1 ollsrt►ts,5A'ur'@ -I1CQ; ,Dry Type of Organization(Please attach documentation of organization's formation and purpose) J ❑Agricultuioi and Horticultural Soiety x Educational Organization ❑Religious Organization ❑Ci,critable Organization U Cernetely Diganization Name Title of Officers, Phone Number Email Contacts Directors,or Partners dreio E 'tJe.v;e got? - S�74 at4* e..Q CM l a4 .ors ate pyIR��sjexle... o ,.et,sr 3or- 379-- !ao -6 rbee.e.C .5e/Q 5p . �oSA ire P," otwzi rreRslarch. 30g-3qh?- .2/re5 joSh.Me.;error t-hnve4Cen Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles: For more information on 0. 0 _ MISCELLANEOUS TRACTS 25-11-10 TO THE CITY OF GRAND ISLAND XC 2.12 AC HWY PT SW permissive exemptions, 'j. n+a; 1/4 S W 1/4 23.92 AC please scan tt a OR -+v im. • code. 0C :e' 3900 W HUSKER HWY GRAND ISLAND NE 68803 }EiV ED Property described above is used in the following exempt category(please mark the applicable boxes): Agricultural and Horticultural Society ®Educational E Religious El Charitable 0 Cemetery Give a detailed description of the primary use of the property and all other uses of the property:Please attach ALL documents that would support the probity foipossibleiektimption. The burden of proof lies with the organization applying for exemption.Please attach additional pages if needed. All organizations,except for an Agricultural and Horticultural Society,must complete the following questions. Is all of the property used exclusively as described above? rg]YES E NO Is the property used for financial gain or profit to either the owner,the owner or organization making exclusive use of the property,or private individuals? 0 YES lill NO Is a portion of the property used for the sale of alcoholic beverages? []YES lal NO 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? El YES ®NO Under penalties of law,I declare that I have examined this exemption application and,to the best of my knowledge and belief,it is correct and complete.I also declare that I am duly authorized to sign this exemption application. s;gn ... 7Gcici L sr,'cSS I Ai I,A0 5 here Authorized ' nature Title Date Retain a copy for your records. For more information on permissive exemptions.please oo to https:Urevenue..nebreske.gc:/PAD'pormiss✓x v empLocs I For County Assessor's Recommendation j E Approval COMMENTS: 0 Approval of a Portion 0 Denied Signature of County Assessor Date For County Board of Equalization Use Only Approved If the County Board's determination is different from the County Assessor's recommendation,an explanation is required. O Approval of a Portion ❑Denied I decla ')hat to the best of/(n nowled 'and belief,the determination made by the County Board of Equali a on corr, ct pure t 5th the State of braska. )/ .,.-(-e `� CO 'Sigha re of Coun oa Mem er Dat County Clerk:A legible copy of this for'tp(showing the final decision of the County Board of Equalization must be delivered electronically to the Nebra a Department of Revenue within seven days after the Board's decision. Multi-County Information and Programming Services,Inc.(MIPS) I IIIIII IIIII IIIII IIIII IIIII IIIII 11111 11111 IIIII IIII IIII Authorized by Neb.Rev Stet.§§11-202.01 and 77-202.04 96-135-1999 Rev.10-2023 Supersedes 96-135.1999 Rev.9-2022 *400201100*