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<br /> TpB��ILEDWITH App��cation for Exemption Fo�nn
<br /> from Motar Vehicle Taxes
<br /> YpUFi COUNTY by Qualitying Nanprofit Organizations 457
<br /> TR�ASUFiEfi •Read instructions on reverse side
<br /> ApplicanYs Narrte
<br /> County Type of Qwnership
<br /> CR�S�.S ��.N�EI� TN� _ _ L �]Nonprofit
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<br /> Streei or Other Mailing Address C,ounty Number Corporation
<br /> 2251 I� WEBB RD_ PO.. T30X 5885 4�__. ❑other(specity):
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<br /> �i�, State Zip Code State Where Incorporated
<br /> GRA�ID IST�D NE 68802 NF
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<br /> Idontify Pfficers,Pirectors,or Partners _ -
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<br /> Title Name,Address City State,Zip Code __ _ �
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<br /> LIST SPECIFIC DESCRIPTION OFTHE MOTOR VEHIGLES
<br /> •Attach additional sheet if necessary
<br /> _ _ _. _
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<br /> --- Regielrahon Oate or C�ate
<br /> Model Year Body Type VehIcIC Identiticatlon Nwnber of Acquisition it Newly
<br /> Vehicle Make Purr,h35ed
<br /> �� ----. —_.
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<br /> —1`�� _ _ �__ _. — -- _ _ --
<br /> ' - Are the motor vehicles used
<br /> Natura of Use of Motor Vehicle: exclusively as indicated?
<br /> [�AgriculturaVHoiiicultural �Educational n Religious �Charitable n Cemetery
<br /> �
<br /> \- � r �j(�YES �NO
<br /> Give detailed description of use,including an explanation if multiple classifications exist 1. _. T 1drnQ'��� _— a"+
<br /> �5_�L�Sr`d`''}..0..7\0 0� �n�!r e`��S.4��,��.. ��.,�_�"�l.S �.S CGL�. If N�La�e�r`v'�entage �,d� __%
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<br /> lJnder penalties of law,I declare that I have examined this application and,to the best of my knowl dge and be�FaJ�'ias r���r�,a� tCE
<br /> complete.I also declare that I am duly authorized to sign this exemption application,and that the organizati n owrnn�@fd.{�ro��r�q�geg;�nSE��;�/�
<br /> discriminate in membership or employment 6ased on race,color,or national origin.
<br /> s i g n � ,�__. �X ,�,�w.�.��%u-�. .__ I I LS I b
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<br /> . ...^ _.._ , ...— ..._ . Date
<br /> here �Authorized Signature Title
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<br /> I F01�COUNTYTREASUR�R S RECOMMENDATION
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<br /> [�APPRQVAL COMMENTS: .��_ /C�� �O. _.��a"� _ __ ...
<br /> �]DISAPPR�VAL -
<br /> i � J ��� // /� -/�
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<br /> Signature of County rea"surer Date
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<br /> FOR COUNTY BOARD OF EQUALIZA710N USE ONLY
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<br /> [�APPFiOVAI CDMMENTS: —_ __ . —
<br /> i f ( "� �'1_ /
<br /> �]pIBAPPRaVAL — - �
<br /> � � ��ti r ��� ,`-T— � '�--- —.... _
<br /> I Authorized Signature Date
<br /> ..,._ ..,., .. __..... ... � -� � Authorized by Neb.Rev.StaL§'Y'7�202(1)(c)(d),§GO 3,185§6U-3,189
<br /> Nabraska�epe�lment vl Revanue
<br /> 96-253-?-006 Rev.5-2009 Supersedos 96-2�53-2006 Rev.11-200b
<br /> PLEASE MAKE A COPY FOR YOUR RECORDS
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