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Zoi1 <br /> 70�E FILEDWI7H Appiication for Exemption FORM <br /> from Motor Vehicle Taxes <br /> vouR coUNTY by Qualifying Nanprofit Organizations 4,5'�' <br /> 7REASUREfl •Read instructions on reverse side <br /> _ ... _ _. ............. . . _ <br /> ApplicanYs Name County lype of Ownership <br /> C�:NTRAL NEB'RASKA HU[�AiQ� SOCIF'�Y HAi.L - <br /> ____ . . �Nonprofit <br /> StrQet or dther Mailing Address Gounty Number Corporation . <br /> 13�Z SKY�A�IC RD _�±O_ ---_....__ --- C J Other(specify): <br /> �jty State Zip Code State Where Incorporatad <br /> c�n TsT�rn rr� 6sso1 rrE — <br /> - - . .__ _.---- --- ---_._ _ <br /> M1 ers,�irectors,or Pariners <br /> _ _ _. - -- _ <br /> T �� Name Address City,State,Zip Gode . <br /> en i ic - - --.. --- � _ __._. <br /> - �., _ _ 1 _�r9 .��r ��' � -. ` �? - �' '� <br /> _.--- - � . <br /> ---- _ <br /> , '�tloe ��=� S ?.lc�. . � � 1 � � __ l=' r �S'v'O/-- <br /> ����_ , Q <br /> �lr�...,. .. � !Q�l. �'�.��r� . � ` �.. � .. �1 . �1}. . <br /> ..._ - /� � �.r. . q � =/ <br /> �u:r� ' ���f�� � _!?S � � ' 4. l'�z/a L�_ . " 4� �Y c� _�� <br /> _ -�- - <br /> I LIST SPECIFIC DESCRIf'TION OFTHE MOTOR VEHICL�S <br /> I •Attach additional sheet if necessary <br /> f __. _.. . _-.__... _.. __ _ ..._. _. . . _ _ <br /> Registration Date ar Uate <br /> Vehicle Make Model Year 8ody Type �Vehide Identihcation Number of Acquisition if Newly <br /> __ _. .. _. _..... - - -urchased _.. _.- <br /> ��t �. �� 1_. _..4 �h , ? � <br /> _ _._. <br /> fi� _ -- <br /> - � � -�'«-k--�� . 7f,C/����?�I`^ - __. <br /> a-. . _ _ _. . <br /> i <br /> __. <br /> � ; G' -� C? � <br /> '� a�__ . (� c��:��. .�_7 � c __ - <br /> _. _ <br /> �,(a..,�+ _ __... t�'7Q���_ �e .. � Lt- .�... -�CHC�:c�1(.d/2_r- O�y � f/ �.7 �t�/Ca <br /> __. _. _... _ _.... __. _. __._. _. <br /> Nature of Use of Motor Vehicle: Are the motor vehicles used <br /> n Agriculturai/Horticultural n Educational ❑Religious Charit3ble ❑Cemetery <br /> exclusively as indicated7 <br /> Give detailed desrription of use,including an explanation it multiple classifications exist: YE$ n Nd <br /> b h:. � �- �e�l� i 11 --I C7`� � ��-Y� <br /> ��a Y1'1 f���_�r n� `L�-�1v r��_ - � . � Na�9ive p <br /> �.-�--�1���� � ���p►��- _ __ � �_.� c; � a�� ���,�� ����Cl� <br /> � . <br /> �- � c.�. „C��'�l'► i ,r���. . �� _-- <br /> _ <br /> - r _ <br /> � n�c � za�o <br /> _ _ _ -- <br /> llnder penalties af law,1 declare that I have examined this application end,to the qest of my knowledge an belief,it is corr���n�0U1vTY <br /> complete.I also declare that I am duly authorized to sign this exemptipn application,and ihat the organizatipn owni g said propeTiQ[�,q6_s 1pp��g p����� <br /> discriminate in membership or employment dased on race,color,or national origin. ��F{�a��<•,=�NP,NE?E3RASKA <br /> . • <br /> sig � ,��.� ���-�� �� °.r ��f:.� /__ -� ' <br /> , <br /> . _: � � _.....,._� Tdle� Date �J . <br /> he�-�. Au prized Signature <br /> - . _ __� <br /> � �OR CPUNTYTREASURER'S RECOMMENDATION <br /> Y, APPC�PVA.. ... <br /> -- - _ _. _ <br /> --.. . _ _ . <br /> 1 ' COMMENTS: . '� f 1�� _. _._ <br /> � _.._ _.., <br /> L <br /> [-J DISAPI'ROVAL ----... _ <br /> M S i n���( � <br /> r., _. <br /> � f�.. _�.� �u.�zJ --- %�r.� -��p <br /> -. _ - <br /> g untyTreasurer Date <br /> _.. ._.._... . . .. <br /> � FOR CQUNTY BAAR�OF EQUALIZA710N USE ONLY <br /> �]APPROVAL GOMMENTS: -_.. <br /> �DISAPPROVAL � !� /'� ',{� �' - <br /> s �i / �.. 1/ _. . ..__ � <br /> _ - --� ,. - ----- <br /> � � r �/ <br /> � .�' ,��` /`\_ ��.:.,.�.� <br /> , � /� ' <br /> --------- _. , ._. .__._.. _. — --.._ -- <br /> �Authoriz.ed 5ignature / Date <br /> . --.... •--- --._ . .. <br /> Nebraska Oepartmont of Revenue Authorized by Neb.Rev.StaL§77-202(1)(c)(d),§60 3,7$5§60-3,189 <br /> 96-253•2�06 Rev.5•2009 Supersedes 9fi-253�20�6 Rev.11-2�08 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />