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T <br />11i 211°i~9 i3: 10 91'~951?~17 <br />F+ew, A'Y.i 0 <br />SA.....vat <br />oRrra~~E co raF~, <br />a <br />X14:= ~ , <br />AFt~1..iGATtC!'i FaR PROPERTY 1'i1X EX~lPTtt3lY <br />Co~utty ~ ~r~ t'~~„~„ 1'c+•tt ar Ci tr <br />O~ncr <br />Addre:s _ <br />(Su.s: x Covtt9 (~c.-.si tSt•te) {a;.ip Gaol) <br />LaaLq~ of Pr+NM ~ . <br />pVSTRtICT10P-S <br />tltNrt ~l1r vavisiaaa of G. 3. tOS-22:.2 t•~ s.nsr e( si+vttlr deia:ns .xmr3ew ov •xdesi++ ka siogerer +asu o~tat <br />damettaent. tks::8e yroassp .•.ts cb• atsattwer nctwiro•e•ts fr aaawa4aw .i' t;Sasaifi+atitV,. C1ri+w fwr-txsstrciaw K saety- <br />ai+u 9iwit bs lElid Ott Wa nes .r.e.risoe of tAS owner is .wie5 tta+ v~+v.RY is 1•est+d. (a+. te+scs. sidai Q+i.s fit assaq. j <br />eiaw .ahwtd t•eiwdr. slt tsa6 swd ievcoo~s+ox• rwd yec:wA) if••++rsf' yidgpd thar•N twd ausvi=ts :Afrgr•iva ntudi•i its •os. <br />S-~ i <br />4 <br /> <br />Tht:vndrrsi=si=d o+vncr or •uthoris=d rrycesantali~e ho::t:by pcticiatss For ezt+npsiaa of t!(e failowittt da:Gibcd prap- <br />?.. Gire Contpiet: dcsc;iptica ai property: -~.r.. <br />L.nnd. <br />intprovc:rtessts: <br />~-~- <br />"~.-"" Pezsaetai Praget2y: <br />.~ <br />3. List aad sxpiaiti th petpcses !ar *~ i+cit the proAcrty is used: ~ w _ ~-. <br />3, if 3rsY argaaizatia: other thsxs rite awttcr uses th0 prapcrty. 6ivc tha name: oC the ors;;aizatiae. fait particaiacs <br />re:nrtfinr i:s use ci the properly and the amauat of arty incatne r=ceivrd iflr such ate. ,,., <br />S_ GiYa ;oar :s:iiT.Att: of the trtn vaiue b. List the itsaarante •aive: of the propcrry: <br />in mane:y o~the proporsy: ~xxxx:ta~zxxzxxxazxaxxzxxSxxzxzxzxzxzzs <br />Land - '~3 ~~ <br />Pezsaet3t Prope:r:y: ~ ~'~"` <br />5_ Upon what uses e^ pu:past:(: do yoV bass this ciaun for cz=tapccoa? Qtsricabic s,~?!' AeiiYioas (): V <br />Eduextiote:i { ); Literary { ); Seiestsific f ); dthsz ~ ,+~~ --- <br />i, Giti`e tha s ti::e !tscutary aeithority aer wlsictt t~is raparrr i~ e~aim~ =s azcrnot. 1,~.;.~~~--. <br />(Frtil trsrs o~J a!-1 rssrapriox ersd classirit~;ia+e ssteiusrt ase avaitaoie as (he o(Tcz a~ the eosurry~~ <br />. - _ _ dFFiR~t.t'fi0it . <br />Vnd.+ yauitics vr•+ctlt+ed btr rry, 1 ha-eir- Aitlt+s tss•s to W b•a¢ a! mf !ae«tedao sod SetiK. tre+ otsetai••wts and iale+rariwn im tt;ls <br />aysyitagii•t ere true rah wtnt!e. aad rn asdR tot ms pactro•. o~'sawp- t ~a aMPw+'q A•rda-tai , U'at• tiw ' <br />5i t el snsr os awAa•r N et aee•e ~ <br />1 L <br />Tina Te/eoneac &o. <br />