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zoli <br /> "(p�E�ILEDWI7H Application for Exemption FORM <br /> from MotarVehicleTaxes <br /> YoUR CoUNTY by Qualifying Nonprofit Organiza#ions 457 <br /> TREASUFi�R -Read instructions an reverse side <br /> _ ---- <br /> _.. <br /> pplicanYs Name Cnunty Type o wners ip <br /> DONIPHAN UIVIlED METEIODIST CHURCH D$A T�ITTLE MIRACLES HALL _., ��Nonprofit <br /> _.. _ ....---------- ----. —. <br /> Street or Other Mailing Address CFIILD CARE C�.NTER County Nurnber Corporation <br /> N 6TH ST P0. BOX ..188 _ ._ Q r]other(specify): <br /> . <br /> --. ., _ <br /> Ci�, State Zip Code State Where Incorporated <br /> NE 68832 �� — - <br /> D._4�Lr�T_ ._ _ <br /> - -- - _ <br /> Identify OFficers,Diroctors,or Partners <br /> _..._ <br /> , _ ._ <br /> Title Namo,Address City,5tate,Zip Code ___ .__ <br /> . _ _.._ _.._ _— — _ -- <br /> i � _ .�ti �t��C`h�'l_'.��. IJ L-�.�'�� ���11��hC?!� !�:=._�4��L�. <br /> 1� r cc�._� _ <br /> _ <br /> _ <br /> f LIST SPECIFIC DESCRIPTIpN OFTHE MO70R VEMICLES <br /> I •Attach additinnal sheet if necessary <br /> _ ------ _ --- <br /> _ �. _.. ... <br /> _... <br /> — -- -- - egistration Dato or Pate <br /> Vehicle Make ModelYear BodyTyp � Acquisition if Newly <br /> urchased <br /> e VPhicle Idrnti(ir.ation Number o T - <br /> __... <br /> .. , � <br /> -- � / <br /> ,3,� �,� :.. ��'4 ��'�-�._ ��1� ZC.'��._ �� <br /> G-�-"�'� IJJ�\1 "4 "�.S`�..�. lyt\^1—... _.��—.. _."V � ., .. _. . � , <br /> —.. _ .. _. _ _ - _- <br /> � __ _... _.._ -- <br /> Natur�of Use of Motor Vehicle: Are the motor vehicies used <br /> �, i� ,�/ exclusively as indicated7 <br /> [�Agricuttural/Horticullural �Educational I X Religious �]Charilable ❑Cemetery <br /> "'1 <br /> � ���r-����� �Y�5 �NO <br /> Give detailed description of use,induding an oxplanation if multiple classifications exist: <br /> °�'� c���U.��l_\"Z"�"���-�� ., a����?`V C.� \� (�+��..�� n`.��__ If Nn,gi e: { . � <br /> C.. ��._. ���� Vo <br /> -- <br /> , CkC_����,.�-e--'�—_... � _ _ _. _ <br /> � � <br /> _ <br /> _ -- . . . -- --- D�C � 7 zp10 <br /> , <br /> Under penalties nf law,I declare that I have examined this applicatinn end,to the best of my knowledg and belief,�i�i�i�p�C� <br /> complete.I also declare that I am duly au[horized tp sign this exemption applicaiion,and that the organization o ning sai ����D NEBr"tASKA <br /> discriminate in membership or employment 6ased on race,color,or national origin. <br /> � � _ t _ <br /> $Ngn � � � � � �� �� �_ �. <br /> - --- <br /> Auitaori d Si n ure 7ftre Date <br /> here ` <br /> _ . _. __� <br /> � _ <br /> FOR COUNTYTREASURER'S RECOMMEN�ATI <br /> , - - <br /> f � , <br /> ` c�5 �%-.-�i:.:..... _. . — <br /> �''�APPROVAL COMMEN7S' �C�! <br /> U C]ISAPPRQVAL _- -- - <br /> � _� � <br /> �. . r,/ �f � /t� !,1 ir �¢�:;. <br /> �Ei� :r�� �..'�!/ ---. _ _. �-- <br /> I Signature of County Treasurer pate � <br /> _ <br /> .._ <br /> — -- <br /> C FOR COUNTY BOARD pF EQUALIZATION USE ONLY <br /> �APPROVAL COMMENTS: --° -- <br /> i ; / �� � � <br /> DISAPPROVAL _. , '�---��� - _..._.. <br /> � <br /> n ���. <br /> _.� <br /> � L . � r-._-_. <br /> —.� �. . _ __... <br /> Authowied Signature f7ate <br /> n�mor�zed by Nen.Re�.scai.4n-zo2(�)(�)ld),§sb-s,ios gso-s,iea <br /> 9G253-2008 Rev.5�2ooa <br /> Nebraska Pcpar[mont ol Revenue <br /> Supersedas 96-253•2006 Rpv.11-7008 <br /> PLEASE MAKE A COPY FOR YOUR RECORDS <br />