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File:oath Your County Exemption Application <br /> For a Qualifying For-Profit NursingFacility,Skilled NursingFacility,or FARM <br /> Assessor on or Y 9 Y> <br /> Before December 31 Assisted-Living Facility 451 111E <br /> I Annual Filing Required <br /> Name of Owner (County Name —i—_-----Tan two —a-_.. <br /> Grand Island Bickford Cottage LLC 'Hall 2026 <br /> Name of Business it Different than Owner <br /> Bickford Cottage of Grand Island <br /> Street or Other Mailing Address of Applicant I City State -- _---_-- Zip Code —^��------ — i <br /> 3285 Woodridge Blvd I Grand Island NE _ 68803 <br /> Contact Name Email Address Phone Number Parcel Number <br /> Debbie Davis ddavis@strategictaxservices.com 3126435000 400448580 <br /> Legal Desorption et Real Property <br /> Brentwood Sixth Sub Lt 1 <br /> _ <br /> Ma'type or for-profit facility is the exemption he nc apphed'o(oiled),all that apply? []. [] <br /> more rntormation on . '_ <br /> Nursing Facility iiii Sib fled Nursing Facildv ®Assrsted•Livinc Facility a arrrt,sstee exemptions. <br /> • <br /> p r r scan tor:OR rode ,• g <br /> Lit.',ft3 <br /> Doe:-this tec;lily ar,:npt Medicaid benefits' ©Yes ❑No <br /> If yes.complete the information below for the most recent three year period from date the form is completed. <br /> The exemption percentage fort each year in the most recent three-year period is equal to a,facility's number ci occupico Medicaid bee::for a given year divide by the facility s total number <br /> of occupied nod for that yet,r The exemption percentage for each year is added together and divided by terse to calculate tnc avenge percen age of occupied Medicaid beds over the <br /> roost recc•'rt three year yeriod.This number is the final exemption pem?ntagC that will be multrpl sd by the'artist:S^roc er'v taxes to determine th,t:..ility I-Cxcmnottcrt amount.Plcace ese <br /> soecibc instructions_enn reverse side rot sage enlume helm. <br /> 1 2 3 4 <br /> -- I <br /> i The three most recent Total number of Total number of Percentage of occupied <br /> years: occupied beds for year occupied Medicaid Medicaid Beds: <br /> specified in Column(1) Beds tor Year Column(3i divided by Column(2'i <br /> Year 1:202 3, 37 6 <br /> Year 2:2024, 37 3 5 U <br /> LYear3:2025 37 y- 1I r� ECEIVED <br /> 5 5a 5b <br /> Calculate the three year Sum of three year Average Occupied JUN:2-9 2026 <br /> average percentage of Percentages from Medicaid Beds <br /> occupied Medicaid beds Column(4) Percentage Column <br /> for exempt purposes i5a)divided by 3 HALL COUNTY ASSESSOR <br /> 23't /i 7 GRAND ISLAND, NEBRASKA <br /> Under penalties of I, t.1 de tare that I have examined this exemption application and.to the rest o'my knowledge ono nelSet,ii is correct and complete. <br /> I also declare th I n d authorized to sign this exemption appbcefion. <br /> sign ► _ . ..)_R. ti(ul— June 30, 2026 <br /> here Authorized aign>ture `illy Date <br /> Retain a copy for your records. <br /> For County Assessor's Recommendation _ <br /> Approval for --_ o COMMENTS: <br /> tuee . t1,( rkr Or dattinidrrilt 3r'1 <br /> letrjnied <br /> I I` `�,. <br /> ► Sir C es ir — [kip". <br /> ..' �I/, <br /> For County Board of Equalization Use Only <br /> Approved for °o ii i he County Board's determrnotiori is dill ref l•t o thy •,A bSe6_O, .recommendation.an explanation is required <br /> )4 Denied <br /> €2"4 <br /> tg fire of Count, Board Member Om <br /> County Clerk:A legible copy of this fo showing the final decision of the County Board of Equalization <br /> must be delivered electronically to the Nebraska Department of Revenue within seven days after the Board's decision. <br /> Nebra:k:,Department o'RPVeni:c...Property Assessmnnr Division A.;ttro'inr tr-,Net,Re,•.Slat ;F,'?,2o2 <br /> 9fea,t5 2020 Rev.12.202.1 <br />