Form 451 - Exemption Application

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Exemption Application
TO BE FILED WITH
FORM
YOUR COUNTY
for Tax Exemption on Real and Personal Property by Qualifying Organizations
451
ASSESSOR
Read instructions on reverse side.
Failure to properly complete or timely file this application will result in a denial of the exemption.
Name of Organization
County Name
Tax Year
Name of Owner of Property
State Where Incorporated
Total Actual Value of Real and Personal Property
Parcel ID Number
Street or Other Mailing Address of Applicant
$
State
Zip Code
Phone Number
City
Contact Name
Type of Ownership
Educational Organization
Religious Organization
Charitable Organization
Cemetery Organization
Title of Officers,
Name
Address, City, State, Zip Code
Directors, or Partners
Legal description of real property and general description of all depreciable tangible personal property, except licensed motor vehicles:
Property described above is used in the following exempt category (please mark the applicable boxes):
Agricultural/Horticultural Society*
Educational
Religious
Charitable
Cemetery
Give a detailed description of the use of the property:
All organizations, except for an Agricultural/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 or organization making exclusive use of the property? . . . . . . . . . .
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
complete. I also declare that I am duly authorized to sign this exemption application.
sign
here
Authorized Signature
Title
Date
FOR COUNTY ASSESSOR’S RECOMMENDATION
APPROVAL
COMMENTS:
APPROVAL OF A PORTION
DENIAL
Signature of County Assessor
Date
FOR COUNTY BOARD OF EQUALIZATION USE ONLY
I declare that to the best of my knowledge and belief, the determination made by the County Board of Equalization is correct pursuant to the
laws of the State of Nebraska.
APPROVED
COMMENTS:
APPROVAL OF A PORTION
DENIED
Signature of County Board Member
Date
COUNTY CLERK: A legible copy of this form 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.
RETAIN A COPY FOR YOUR RECORDS.
Nebraska Department of Revenue, Propety Assessment Division
Authorized by Neb. Rev. Stat . §§ 77-202.01 and 77-202.04
96-135-1999 Rev. 7-2012 Supersedes 96-135-1999 Rev. 7-2010

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