To send in an inquiry to become a resident please click the form below to download:

Or click here to download the application.

***PLEASE NOTE: ONLY USE ADOBE READER TO FILL OUT AND SAVE YOUR FORM CLICK HERE FOR INSTRUCTIONS OR CLICK HERE TO DOWNLOAD ADOBE READER***

After filling out the form please submit it to us by one of the following means:

Mail: 1203 E Hynes • O’Neill, NE 68763

Email: administrator@countrylaneretirement.com

Fax: (402) 261-3963

Phone: (402) 961-1358

If you are experiencing issues you can click here to view the instructions page.