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<br /> Applica#ion for �xemption
<br /> rn s���_�o wir� FORM
<br /> `rUUR COUNTY from Motor Vehicle Taxes
<br /> r�t�ASURER bY Clualifying Nonprpfit Drganizations 457
<br /> •Read instrucfions on reverse side
<br /> ApplicanYs Name � County Type of Ownership
<br /> S _ 1!+r�CL r��'f.� �� ._ G� U 1 ��
<br /> �C7�.'k7�_..f.._�0-......_—�...�.T.. ��-_r_,._.� _.� 0.�� �O�.r1 � �Nonprofit
<br /> Street pr pther Mailin Address m"��
<br /> _ County Numb�r Corpnration
<br /> ����J �1 Y'YZh�'("\ 1J1�. c�'j`�C�e{ j V
<br /> City State Zip Gode State Where Incorporated �Qther(specify);
<br /> �^ L%��l s ��� /`4� _._.. �b a Q�� ��... ---......,.,.._.
<br /> Tit etiFy Officers,Directors,or Partners
<br /> _... ._.-------.._.�_. __ _....._ .....-�
<br /> Name,Address,City,State,Zip Code
<br /> _ __..._�_.__.,..,... �
<br /> _ ,., -�, „ ,,,-, r
<br /> e� d��a� Q iS -- - ..._. �..- _ ._ �. -�_.- _
<br /> . --.�... _.-------.—.. .. _. _ .. _...._.._ ......_._
<br /> I _..._�
<br /> LIST SPECIFIC DESCRIPTIQN pFTHE M07�RV�HICLES
<br /> �Attach additianal sheet if necessary
<br /> __.,..._ ...,..._ , _ —.
<br /> Registra�ion Qate or f]ate
<br /> VChicle Make Modol Year Body Type Vehicie Identification Nurnher of Acquisition if Newly
<br /> - — — ._ ---
<br /> Purchased
<br /> _. d --- _ _o�c� E
<br /> o Lus �,.��3FL�(�oR(�r4q8` �I fo?�ac��o
<br /> _.�c�sr�_.— .ao 0 3 v�a�Q,r� 5 �F/�j,�A 5���13 Q 5�3 3... „.,l t_�/�Q►_�..—
<br /> Nature oi Use oi Motor Vehir,le: ~ Are the motor vel�icles used
<br /> �Agricultural/HOrticultural �Educationat �Religious �X Charilable �Cemetery exclusively as indicated?
<br /> Give detuiled description of use,including an explanation if multiple classifioations exist: _ � �YES �NO
<br /> �.�e1��rt.,,r,e,r.� Ce,�•�,�uv,� � i+ti��iv� S�,I1�ed tJ►�vs:w,y _ irNO,������-�
<br /> ��;� s�;� L;�;�� u�:�, �.�.a �.w,;� ���; �a;t►�.
<br /> �e�U;�s .
<br /> _.._..._ i!��' � � �0��
<br /> F1F,!..L COUNTY
<br /> r"'-r�
<br /> Undcr penalties of law,1 declare that 1 have examined this application and,to the best of my knowledge and belief,'if 1s`Ctirr`�cX a d�
<br /> i �) I�":��-.SI=:,�,vc.A
<br /> complete.l also declare t�t 1 aru�uly-autFiorize to sign this exemptinn application,and that the organization owning said property_ddPS.iw .....
<br /> discriminate in m � or employment b ed on race,color,or nativnal origin.
<br /> sign
<br /> here �Au rized Signatu� �.� 5 �� � Titl�.�~ .— D�t�� ��f�
<br /> k� �
<br /> -- - --- --_._.�. ...__.�
<br /> FOR NTYTREASURER'S RECDMMENDATION
<br /> [�APPROVAL COMMFNTS: _•��� ��� f ����'�'�' m.___. _..,__
<br /> �
<br /> �DISAPPROVAL _,.._._ __.�_.._ . _
<br /> � �� �J /'d �y�/C.3
<br /> Signature of County Treasurer 4 � Uate
<br /> FOR CbUNTY BpARp O�EGIUALIZA ��
<br /> _ __
<br /> TION USE pNLY
<br /> ❑Af'h�ROVAL ,, COMM[NTS: ..,,..
<br /> � _._...__.�—. __....._�
<br /> �DISAPPROVAL " %
<br /> -- -... _....
<br /> � �... _._....__
<br /> ► rr�r. —.�
<br /> Auth ized Signature m � � Date
<br /> _ _. . .,._...... --_..,.......----
<br /> �. .__..._..� _... __
<br /> NebraSka Depaftment pf Revenue AuthoriZed by Neb.Aav.6tat.§77-"L02(1)�c)(d),§6U-3,785§60-3,789
<br /> 96-253-2006 Hev.5-2�09 SuperSedes 96-253-2006 Rev.17-2008
<br /> PLEASF MAKE A CbPY FpR YpUR �ECORDS
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