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File with Your County Exemption Application FORM Assessor on or for Tax Exemption on Real and Personal Property by Qualifying anizat ' s 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 a do Name of Organization County Name Year FRIENDSHIP HOUSE INC HALL _ 2026 Name of Business if Different than Organization State Where Incorporated NEBRASKA Name of Owner of Property Value of Real Property!Value of Personal Property Parcel ID Number FRIENDSHIP HOUSE INC $300,000 $250,000 0400068885 Street or Other Mailing Address of Applicant Contact Name Phone Number 406 W KOENIG ST CHERYL WASSON 308-675-3345 City State Zip Code Email Address GRAND ISLAND NE 68801 cwasson@thefriendshiphouse.net Type of Ownership ❑Agricultural and Horticultural Society ❑Educational Organization ❑Religious Organization ®Charitable Organization ❑Cemetery Organization Title of Officers, Name Directors,or Partners Address,City,State,Zip Code Tara Lesiak Executive Director Clarks, NE Jim Truell President Grand Island, NE RFCEIVIM Sandra Berggren Secretary _Grans Island, NE Legal description of real property and general description of all depreciable tangible personal property,except licensed motor vehicles 2 i 't�L 0 LG25 PACKER & BARR'S FIFTH ADD LT 2 S-T-R: 0-11-9 !-TALL GOUIN i Y ASSESSOR 610 N DARR AVE GRAND ISLAND NE 68803 GRAND=SL AND,NEBRASKA Property described above is used in the following exempt category(please mark the applicable boxes): ❑ Agricultural and Horticultural Society ❑ Educational E Religious ® Charitable ❑ Cemetery Give a detailed description of the primary use of the property and any other uses of the property: Halfway house for adult males. All organizations,except for an Agricultural and Horticultural Society, must complete the following questions. Is all of the property used exclusively as described above? ®YES ❑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? ❑YES ®NO Is a portion of the property used for the sale of alcoholic beverages? ❑YES ®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?... ❑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 completedalsokdeclare that I am duly authorized to sign this exemption application. sign y` DIRECTOR OF ADM SERVICE 12/26/25 here Ai horize ionature Title Date Retain a copy for your records. For County Assessor's Recommendation ❑ Approval COMMENTS: ❑ Approval of a Portion ❑ Denied Signature of County Assessor Date For County Board of Equalization Use Only 2(A-pproved If the County Board's determination is different from the County Assessor's recommendation,an explanation is required. ❑ Approval of a Portion ❑ Denied I declare that to the best my no ge and belief,the determination made by the County Board of Equalization is corrct pus u o t a he State of Nebraska. ¢� e Sigute of ountf-nE:1 Board Member Dat County Clerk:A legible copy of this forrn..showing the final decision 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 Department of Revenue,Property Assessment Division Authorized by Neb.Rev.Stat.§§77-202.01 and 77-202.04 96-135-1999 Rev.8-2021 Supersedes 96-135-1999 Rev.3-2020